Physeal Closure and Fracture Pattern in Adolescent Transitional Distal Radius Fractures

Purpose: To show a correlation between grade of physeal closure and fracture pattern in adolescent transitional distal radius fractures. Methods: A retrospective chart review was performed of 490 distal radius fractures, ages 14 to 18, at a single institution between 2007 and 2020. A board-certified orthopaedic hand surgeon reviewed all images. Thirty-six distal-radius fractures were considered adolescent transitional fractures. The review included Salter-Harris classification, fracture fragments, and grade of physeal closure. Results: Distal radial physeal closure is 50 times more likely to be of a higher grade in the presence of Salter-Harris type IV fractures (P<0.001). Closure of the physis is also 7.37 and 13.08 times more likely to be of higher grade in the absence of a dorsal metaphyseal fracture and in the presence of an ulnar corner fracture, respectively (P=0.011 and 0.021). Conclusion: Adolescent transitional fractures of the distal radius occur when the growth plate has a partial closure. The closure pattern of the distal radial physis begins centrally, with subsequent ulnar and then radial closure. In this cohort, there is a correlation between grade of physeal closure and fracture pattern in adolescent transitional distal radius fractures. Level of Evidence: Level IV - diagnostic.