Distal radius physeal separation

　　1. Etiology

　　It is mostly caused by indirect violence.

　　2. Pathogenesis

　　It is almost completely similar to distal radius Colles fracture, and some cases are similar to Smith fracture, mostly caused by violence transmitted from the palm or back of the hand. In the past, the most common cause was that the driver suddenly released the hand lever when reversing the engine, and the handle was directly struck by the reversed hand. This phenomenon has now disappeared and is more common in impact injuries (such as collisions when riding on a moped or motorcycle) or falling on the wrist backside.

　　In severe cases, complications such as early closure of the epiphysis may occur if the treatment is not appropriate.

　　Epiphyseal line closure refers to the fact that the natural growth potential has been lost. Early closure of the epiphysis refers to the epiphyseal plate cartilage of the immature bones in children, which may have developmental disorders due to various congenital and acquired causes, leading to early closure of the epiphyseal plate cartilage earlier than the age, and thus affecting the normal development of bones and joints to varying degrees, resulting in bone and joint deformities.

　　1. Fracture symptoms:Swelling, pain, and tenderness (often annular) appear on the dorsal side of the wrist after injury.

　　2. Other symptoms:Including limited wrist joint movement and the wrist of the affected side showing a fork-like deformity. According to the X-ray findings, it is divided into the following 5 types.

　　Type I fracture line completely passes through the weak zone of the epiphysis plate, which is less common, accounting for about 10%.

　　Type II is similar to the former, but there is often a triangular fracture fragment torn off at the edge of the bone, which is the most common type, accounting for about 70%.

　　Type III fracture line enters the epiphysis from the joint surface to the epiphysis plate, and then extends along one side of the weak zone to the edge of the epiphysis plate, which is a rare type.

　　Type IV is similar to the former, but the fracture line enters the epiphysis from the joint surface and continues to extend forward through the weak zone to the epiphysis end, forming a similar Paterson fracture-like displacement; and the fracture fragments are unstable and prone to displacement, which is rare in this type.

　　Type V is a compressed type, that is, a compressive fracture of the epiphyseal cartilage plate. The diagnosis of this type mainly relies on the doctor's clinical experience, which is prone to misdiagnosis and may not be discovered until the late stage when the epiphysis closes early and stops growing. It is necessary to be cautious in clinical practice. For patients with pain after wrist injury, with annular tenderness along the epiphysis line, this type of injury should be considered, and treatment such as reduction and fixation should be given.

　　Referring to the prevention methods of fractures, several methods of prevention and protection against fractures can be considered:

　　1. Exercise to Strengthen the Body:It is necessary to actively and continuously engage in exercise, increase outdoor activity time, breathe fresh air, and promote the circulation and metabolism of the whole body. Activities such as walking, jogging, Tai Chi, and health exercises can be chosen. More activity can make more calcium in the blood stay in the bones, thus increasing bone hardness and effectively reducing the occurrence of fractures.

　　2. More Sun Exposure:Sunlight can promote the synthesis of vitamin D, and calcium metabolism depends on the effect of vitamin D; ultraviolet rays in sunlight can promote the formation and absorption of calcium in the body, maintain normal calcium-phosphorus metabolism, increase calcium in the bones and increase bone hardness.

　　3. Prevention Before Illness:The elderly should not go to places with many people and cars, and should not go out during rain, snow, or when there is water on the ground or ice, to avoid falling and fracturing. Do not climb ladders or engage in high-altitude activities, and it is not advisable to walk on steep slopes due to weak lower limbs and slow reactions in the elderly, which are prone to falls. When going out, the elderly should walk slowly and carefully. If there are symptoms such as dizziness, deafness, or dizziness, try to reduce going out. If it is necessary to go out, someone should assist in walking or a cane should be used. Before going to the toilet at night, one should sit on the edge of the bed for a moment to make the leg muscles excited and prevent transient hypotension due to changes in position. When taking a bath, a small stool should be prepared, and pants and shoes should be worn while sitting to prevent falls.

　　4. Diet Adjustment:Eating more vegetables, protein, and vitamin-rich foods can prevent the occurrence and development of osteoporosis. The diet in the early stage of fracture should be light and easy to digest, which is conducive to removing blood stasis and reducing swelling. In the later stage, the diet should be more flavorful, and appropriate diet supplements should be chosen to nourish the liver and kidney, which is beneficial to the healing of fractures and the recovery of function.

　　5. Close Observation:After suffering an injury, if there is a suspicion of a fracture, it is necessary to go to the hospital for treatment as soon as possible. During the transport, necessary temporary fixation measures should be taken. For upper limb fractures, the arm should be fixed with a wooden board, the length of which should exceed the upper and lower joint surfaces of the fracture site. The fractured arm can also be tied to the chest for fixation. For lower limb fractures, the injured limb can be bound together with a long wooden board, with the board extending up to the armpit and down over the heel, or the affected limb can be tied to the healthy limb for fixation. Spinal fractures should be transported by two people in parallel to the wooden board for fixation. Cervical spine fractures should have sandbags placed on both sides of the head to limit head movement before being transported to the hospital. If there is bleeding, the wound should be temporarily bandaged with clean cloth, and then the tourniquet should be tied. Generally, the tourniquet should not be tied for more than 1 hour at a time, and the tourniquet can be loosened for 1 to 2 minutes every hour until fresh blood flows out, to prevent limb ischemia and necrosis due to prolonged tourniquet time. After the fracture is fixed with plaster or other methods, the skin color changes and swelling of the injured limb should be closely observed within 24 hours. If swelling intensifies or the skin becomes bruised, immediate medical attention should be sought, and the plaster should be loosened or removed to prevent limb ischemia and poor blood return due to tight fixation. During the period of fracture fixation, regular follow-up as advised by the doctor should be followed.

　　6. Functional Exercise:Under the guidance of a doctor, actively exercise the unharmed joint, 100 times per hour every day, can avoid joint stiffness, contracture, and muscle atrophy. Self-massage with light massage can promote local blood circulation and is beneficial to the recovery of the fracture.

　　In order to make a diagnosis, in addition to relying on its clinical manifestations, it is also necessary to rely on auxiliary examinations. There are no related laboratory tests for this disease.

　　X-ray Flat Film:It can show the separation and type of the epiphysis; in general, a bilateral wrist joint film should be taken for comparison.

　　What kind of food is good for the body for distal radial epiphysis separation

　　It is advisable to eat light and eat more vegetables and fruits, rationally match the diet, and pay attention to adequate nutrition.

　　(The above information is for reference only; for details, please consult a doctor.)

　　I. Treatment

　　The treatment method for distal radial epiphysis separation is completely consistent with that for distal radial fractures, but the following points should be emphasized more:

　　1. Early Stage:The earlier the reduction, the less impact on the development of the epiphysis.

　　2. Anatomical Alignment:For any type of epiphysis injury, it is necessary to strive for anatomical alignment. Since the epiphysis of children is small and easy to achieve anatomical alignment, for those with soft tissue impaction, open reduction is required.

　　3. Manipulative Reduction:Generally, it is best to try to achieve reduction through non-surgical methods such as manipulation to avoid injury to the epiphysis during open reduction.

　　4. Avoid Internal Fixation at the Epiphysis:Any internal fixation that affects the normal development of the epiphysis should be avoided, and if it is necessary to use it, it should be chosen to avoid the bone quality at the epiphysis line.

　　5. Avoid Injury:Repeated manipulations are bound to increase the injury to the epiphysis and cause early closure, leading to the appearance of Madelung-like deformities later on. Therefore, it should be achieved in one go during the operation, and it should not be repeated multiple times.

　　II. Prognosis

　　In general, the prognosis is good for most cases, but a few severe injuries, improper treatment, and early closure of the epiphysis may lead to a Mandelung-like deformity of the ulna being longer and the radius being shorter, with the wrist radially deviated, several years later. This kind of deformity brings inconvenience and pain to patients, and it can be corrected by the excision of the styloid process of the ulna.