Success Rate of Distal Radius Epiphysiodesis for Progressive Pediatric Wrist Deformity: A Pilot Study

Ulnar epiphysiodesis is a well-described treatment of distal radius physeal arrest in children, but no studies have evaluated the utility of distal radial epiphysiodesis for wrist deformity secondary to either developmental pathology at the radius or premature physeal closure of the distal ulna.

Skeletally immature patients with wrist deformity who underwent distal radial epiphysiodesis at a single center from 2008 to 2019 were retrospectively reviewed. Patients were subdivided as either Traumatic (distal ulna premature physeal arrest) or Atraumatic [hereditary multiple osteochondromas (HMO) or Madelung's deformity]. Demographics, preoperative and final radiographic measurements, including ulnar variance, volar tilt, and radial inclination, were recorded. Failure rate of epiphysiodesis, defined as lack of radial physeal closure, and clinical symptoms (extracted retrospectively from clinical progress notes), including preoperative and postoperative pain at rest, pain during activities, strength, joint instability, and reduced wrist range of motion, were recorded.

A total of 48 wrists among 44 children (37 Traumatic and 11 Atraumatic with mean ages of 13.1 years and 11.5 years, respectively, P=0.669) met criteria with mean follow-up of 9.0 months (Traumatic) and 43.8 months (Atraumatic), P<0.001. Distal radius epiphysiodesis was performed as an isolated procedure in 5 wrists and with concomitant procedures (osteotomies, distal ulna epiphysiodesis, or exostosis excision) in 43 wrists. Distal radius epiphysiodesis was successful in achieving physeal closure in 93.8% (45/48) of wrists. The three wrists that did not experience physeal closure were followed for only a mean of 4.4±2.3 months compared with the remainder of wrists at a mean of 17.8±20.1 months. Ulnar variance and radial inclination showed no significant change after radial epiphysiodesis in the overall cohort; however, in the Atraumatic cohort, radial inclination improved postoperatively from 31.6 to 26.6 degrees (P=0.036). There were no instances of instability preoperatively or postoperatively, and no complications were noted.

Distal radial epiphysiodesis may be successfully performed in the setting of children with wrist deformity related to overgrowth (traumatic distal ulna injury) or abnormal growth (atraumatic changes at the distal radius), with what appears to be a very low complication risk.

Level IV.