Distal Radial Epiphysis Injury: Causes, Symptoms, Treatment- Surgery, PT, Exercises

The epiphysis is the rounded portion of the distal end of the radial or long bone of the forearm known as the growth plate. The word distal refers to the ending edge at the bottom of the radial bone. A distal radial epiphysis⁽¹⁾ injury is a condition in which an injury is caused to the end point of the radial bone of the wrist.

Distal radial epiphysis injury most frequently occurs to adolescent athletes, generally between the age group of 6 to 10 years, who have still not reached skeletal maturity. This particularly happens while performing the sports activities such as gymnastics or as a result of falling down on an outstretched hand.

Stress injuries to the distal radial epiphysis are quite uncommon. This injury occurs due to inability of the growth plate to withstand mechanical forces such as compression and torsion. Repeated torsional forces to the wrist may cause stress fractures of the distal radial epiphysial plate.

• Landing on the outstretched hand.
• Falling down in sports such as football and soccer.
• Bike accident.
• Skiing accident.
• Snowboarding accident.
• Falling down from a height.

• Acute pain after an impact or fall.
• Swelling.
• Tenderness.
• Appearance of bruising.
• Displacement at end of the bone in the wrist could lead to deformity.
• Pain with movement of arm or wrist.
• Hanging of wrist in an odd way or in bent position after injury.

Most of the epiphyseal injuries are treated nonoperatively. Conservative care may involve closed reduction under local anesthesia followed by casting or splinting. Manipulation and traction should be performed carefully during closed reduction with the involved musculature as much relaxed as possible as forceful manipulation may result in damage to the growth plate arresting bone growth. Focus should be less on manipulation and more on traction to avoid epiphyseal damage⁽²⁾ as much as possible. Regular x-rays may be needed for continuous monitoring to ensure that the bone has maintained its proper position and alignment.

Casting is applied to the broken bone which has maintained its normal position despite injury just to support it until it gets healed.

• In cases where deformation is to an extent that manual therapy cannot treat it, then surgery becomes necessary. This is done by a procedure called as open reduction.
• Surgical procedure is done by creating incision to expose the fracture and then get it back to its usual position. It sometimes requires use of pins, screws, or external fixators etc.
• Surgery includes risks of bleeding, infection, neurovascular injury, etc.

This is necessary for every affected individual to speed up healing and get back normal function of wrist and hands. This includes:

• Bracing.
• Ice or heat.
• Strengthening and flexibility exercises.
• Activity modifications.
• Gradual return to activities.

• Flexion:⁽³⁾ This is done by having the wrist bent in a forward position unless painless stretch is sensed and to hold position for five seconds. This has to be performed in sets of two, 15 times each.
• Extension: This is done by having the wrist bent in a backward position unless painless stretch is sensed and to hold position for five seconds. This has to be performed in sets of two, 15 times each.
• Side to Side: This is done by having the wrist move sideways unless painless stretch is sensed and to hold position for five seconds in each position. This has to be performed in sets of two, 15 times each.

• Wrist Flexion: This is done by holding a handle of a hammer or a similar object with palm put in a position where it is facing towards ceiling. Then wrist is bent upwards. Slowly, the weight is decreased. This is performed in sets of two, 15 times each. The weight of the object is gradually increased.
• This is done by holding a handle of a hammer or a similar object with palm put in a position where it is facing downwards. Then wrist is bent upwards. Slowly, the weight is decreased. This is performed in sets of two, 15 times each. The weight of the object is gradually increased.
• Grip Strengthening: For this exercise, an object hat can be squeezed like a soft ball is used and squeezing it as much as possible without any increase in pain for about 10 seconds and to repeat it at least 10 times.

• X-ray of the wrist.
• CT scan in rare cases.
• MRI in rare cases, generally if surgical treatment is required.

References: