A Complex Injury of the Distal Ulnar Physis: A Case Report and Brief Review of the Literature

Physeal fractures of the distal forearm are common inju­ries in children and adolescents. However, Salter-Harris type III and type IV fractures of the distal ulnar epiphysis are often high-energy injuries that require open reduc­tion for restoration of anatomical alignment. These injuries are uncommon and there are few descriptions of them in the contemporary literature.

Here we report the case of a 13-year-old boy with a type IV distal ulna fracture not diagnosed with standard radiography. After closed manipulation, an incompletely reduced physis was suspected on the basis of fluoro­scopic imaging and comparison radiographs of the con­tralateral wrist. Computed tomography showed a large, displaced physeal fragment. The patient underwent open reduction and internal fixation.

Thorough radiographic assessment should be con­ducted when there is a high suspicion for these fracture patterns. Appropriate diagnosis can lead to expedient reduction and expectant management of sequelae asso­ciated with these injuries.