Premature closure of the distal radial physis without evident history of trauma

Rationale: The distal radius is the region of the body with the highest incidence of physeal injury. However, it is uncommon for the distal radius to undergo growth arrest without a history of trauma. We present a case of premature closure of the distal radial physis without evident history of trauma in a girl. Patient concerns: A 14-year-old girl presented with chronic progressive deformity and painful functional limitation of her right forearm. The right wrist pain had begun when the patient was 5 years old. There was no evident history of trauma. The deformity and persistent right wrist pain had prevented her from performing sports activities and activities of daily living. Diagnoses: Radiography and computed tomography showed a volarly angulated distal radius and dorsally protruding distal ulna with a length discrepancy between the distal radius and ulna due to premature physeal closure of the right distal radius. Interventions: To eliminate the deformity and achieve painless functional recovery of the wrist, an opening wedge osteotomy of the distal radius with an iliac bone graft was performed, followed by a shortening osteotomy of the distal ulna. Outcomes: Radiography at final follow-up 1 year and 9 months postoperatively showed good alignment of the distal radioulnar joint without length discrepancy between the two forearm bones. The range of motion of the left wrist had reached 100% of the contralateral wrist without any pain, and the right grasp strength was 18 kg, which was 82% compared with the dominant left wrist. Lessons: Premature closure of the distal radial physis impairs the growth potential of the physis and leads to wrist dysfunction due to deformities. In the present case, a satisfactory outcome was achieved via corrective osteotomy of the distal radius with an iliac bone graft combined with ulnar shortening osteotomy.