epiphysiodesis of the radius [clinical case IWAS forum]

epiphysiodesis of the radius [clinical case IWAS forum]



Dear colleagues,

I ask your opinion for this case of this young patient who has a painful wrist. Thank you
 
Dr Pierre AUZIAS
docteur.auzias@gmail.com
Clinique Lille Sud (France)

Dear Pierre,

Find attached a simple and easy reversible solution I use.
Larger series is under review at the moment.

Best wishes, Sebastian
Sebastian Farr, M.D. 

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I would perform an arthroscopy and debride tfcc and evaluate the impacting situation.
Secondarily I would perform a distractive Osteotomy of the radius to restore functional hight. In my hands there is not an indication for ulnar shortening or wafer.
One can discuss performkng an iatrogenic epiphysiodesis of the ulna additionally, but I would not do it regularly.

best wishes,
d r  .  j u s t i n    h a s e n e c k e r,  f e b h s


Dear Pierre

As the patient already have symptoms I think it is to late with an temporare epiphysiodesis. I would scope and evaluate ulnar compartment and almost certaninly do an ulna shortening osteotomy. At least 5 mm as the ulna is still growing. 

I have done distraction radius osteotomies (Ilizarov) on Madelung deformities and it is a troublesome procedure for both patient and surgeon. 

Best wishes
Peter Jørgsholm
Hand Surgeon, PhD

Denmark

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Dear Pierre:

I think the enlargement of the radius is too embarrassing procedure for patient and surgeon. The difference between the longitud of the right and left arms I think would not be too high then I prefer to do an epiphisiodesis of the ulna and a shortening of it.

The idea of perform an arthroscopy is excellent, I can see and treat the impaction sindrome and repair the triangular fibrocartilage, also I can see the result of the shortening.

Dr Fidel Cayón
Presidente
Sociedad Ecuatoriana de cirugía de mano

Ecuador.

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In my opinion pain is the ideal indication for temporary epiphysiodesis in the technique I sent you (if no pain then no treatment anyways!). There is still enough growth in the distal ulna and you do not burn any bridges for later shortening.

Of course, patient should be counseled that pain will disappear only after several months, and you should confirm with MRI that TFCC is intact.

My best,

Sebastian Farr, M.D.
Associate Professor of Orthopedic Surgery


 

Pic

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