Wrist deformities after fracture.

Wrist deformities can occur after fracture because of malunion of the fracture or injury to the growth plate leading to imbalance of growth. Prevention of malunion is paramount by early recognition with proper reduction and casting or fixation with casting. If a mal-union occurs, an osteotomy may be necessary if anticipated growth will not correct the deformity. Injury of the growth plate may lead to wrist deformity in two ways: angular growth or growth arrest. Angular growth deformities are corrected most commonly by osteotomy. Growth arrest of the radius or the ulna leads to an ulnar-positive or an ulnar-negative variance at the wrist. If the ulnar variance is symptomatic, treatment is centered on achieving a level joint. Options for joint leveling procedures include epiphysiodesis or physeal stapling of the longer bone, lengthening osteotomy of the shorter bone, or shortening osteotomy of the longer bone.