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대한골절학회지제 21 권, 제 3 호, 2008 년 7 월 Journal of the Korean Fractrure Society Vol. 21, No. 3, July, 2008 소아에서요골원위골단판골절 김휘택ㆍ윤명수ㆍ이종서ㆍ최영준ㆍ성윤재 부산대학교의과대학정형외과학교실 목적 : 소아에서발생한요골원위골단판골절의치료결과를분석하였다. 대상및방법 : 치료후 1년이상추시 ( 평균 3.2 년 ) 된 23 예를도수정복과석고고정을시행한 1군 (6예 ) 과도수정복및 K- 강선고정술과석고고정을시행한 2군 (17 예 ) 으로나누었다. 술후및추시관찰엑스선에서골단판의잔여전이정도와골단판의경사도를비교하였다. 결과는방사선학적기준 ( 요골측경사, 수장측경사, 요골단축 ) 과임상적기준 ( 운동범위제한, 동통, 파악력, 완관절의변형 ) 으로양호, 보통, 불량으로분류하였다. 결과 : 1군은양호 5예, 보통 1예를보였으며 2군은양호 14예, 보통 2예, 불량 1예를보여양군간통계학적차이를보이지않았다. 정복후 30% 이하의골단판전위는만족스럽게재형성되었다. 불량을보인예는조기골단판의폐쇄와함께요골단축, 완관절의변형을호소하는경우였다. 골단판폐쇄가발생한예에서는골교제거술, 지방조직의이식, 요골절골술, 척골골단유합술, 요골연장술등을시행하여만족할만한결과를얻었다. 결론 : 전위된소아요골원위골단판골절은비교적풍부한재형성력을기대할수있다. 정확한정복을이루기위한과도한도수정복은이차적골단판손상을야기할수있으므로주의해야한다. 색인단어 : 요골원위골단판골절 Fractures of the Distal Radius in the Children Hui Taek Kim, M.D., Myung Soo Youn, M.D., Jong Seo Lee, M.D., Young Jun Choi, M.D., Yoon Jae Seong, M.D. Department of Orthopaedic Surgery, College of Medicine, Pusan National University, Busan, Korea Purpose: To evaluate the long-term results of treatment of epiphyseal fractures of the distal radius in children. Materials and Methods: 23 cases of distal radial epiphyseal fracture, treated by two methods: group 1, closed reduction (CR) plus cast (6 cases); group 2, CR and K-wire fixation (under anesthesia due to marked translation of the distal fragment and swelling) plus cast (17 cases), were selected for this study. All patients were followed up for more than 1 year (average: 3.2 years). Postoperatively, epiphyseal displacement and epiphyseal angulation were measured on anteroposterior and lateral radiographs. At follow-up, the affected and normal sides were compared. Final results were classified by radiologic (radial inclination, volar tilting and radial shortening) and clinical (limitation of ROM, wrist pain, grip strength and wrist deformity) criteria. Results: Group 1 had 5 good, 1 fair result; group 2 had 14 good, 2 fair and 1 poor - there was no statistically significant difference between two groups. All cases where the epiphyseal displacement was less than 30% had good results. A poor case showed a radial shortening, wrist deformity and pain due to premature epiphyseal closure. Premature epiphyseal closure was treated by bar resection and free fat, along with corrective osteotomy when necessary and lengthening of radius with or without epiphysiodesis of the ulna. Conclusion: Remodeling can be expected in epiphyseal fractures of the distal radius. Repeated forceful attempts to achieve accurate reduction should be avoided to prevent secondary physeal injury. Key Words: fracture of distal radius 통신저자 : 김휘택부산시서구아미동 1 가 10 부산대학교병원정형외과 Tel:051-240-7248 ㆍ Fax:051-247-8395 E-mail:kimht@pusan.ac.kr Address reprint requests to:hui-taek Kim, M.D. Department of Orthopaedic Surgery, Pusan National University Hospital, 10, Ami-dong 1-ga, Seo-gu, Busan 602-739, Korea Tel:82-51-240-7248ㆍFax:82-51-247-8395 E-mail:kimht@pusan.ac.kr 225

226 김휘택, 윤명수, 이종서, 최영준, 성윤재 서 소아골절의약 15 18% 가골단판을침범하는골절이며이들골단판골절의 30 60% 는 Salter-Harris 2 형골절이고이중 74% 정도가원위요골에발생한다 11,13,14,17,18). 원위요골의골단판골절은전위된골간단부의골절치료와유사하나 3 4 주간의고정으로빨리치료되며재형성의능력이매우크다는차이가있다. 또한 3 7 일이지난후도수정복의시도는골단판의손상을가중시킬수있다 11). 원위요골이골단판손상의가장흔한부위임에도불구하고골교 (bone bridge) 의형성이나조기골단판폐쇄에따른성장장애는드물다 15). 조기골단판폐쇄는골단판의직접적인손상, 장기간의고정이나수술적인침습에의한골단판의허혈, 과다한반복적인도수정복에의한골단판의압박손상등에기인한다. 조기골단판폐쇄의주증상은부분적혹은완전성장정지로인한각형성과길이자람 론 의장애로인한손목변형이며이에대한치료방법은매우다양하다 2,3,5,8,11,12,15,16,19,21,22). 저자들은소아에서발생한원위요골골절과동반된골단판손상에대한치료결과를 1 년이상의추시관찰이시행된증례들을통해분석하였다. 대상및방법 1996 년 7 월부터 2004 년 2 월까지원위요골골절을수상후내원한환아는총 152 예였으며이들중골단판골절을동반한경우는 52 예였다. 골절의치료는골절의전위와종창의정도가비교적경한경우도수정복과장상지석고고정을시행하였고 (28 예 ), 심한경우무리한도수정복으로인한골단판손상의위험을최소화하기위해서수술방에서도수정복을시행하였다. 이경우종창완화후석고내에서의정복소실을방지하기위해모든예에서 K- 강선 Table 1. Summary of patients Cases Age at op. (years) Sex S-H type Postoperative epiphyseal angulation/displacement AP Lateral RS at last F/U (mm) Results Complications CR+cast group 1 8.8 M II 12 o /30% 8 o /14% 1 Good 2 13.5 M I 7 o /11% 5 o /9% 1 Fair 1* 3 10.2 M II 4 o /9% 4 o /10% 0 Good 4 12.4 M I 5 o / 0% 4 o /0% 1 Good 5 10.8 M II 3 o /8% 0 o /3% 2 Good 6 14.6 F II 5 o /15% 3 o /25% 0 Good CR+K-wire fixation+cast group 1 10.9 M II 0 o /10% 5 o /10% 5 Poor 1*, 2 2 15.1 M II 4 o /5% 0 o /5% 2 Good 3 15.3 M I 9 o /3% 5 o /2% 2 Good 4 15.6 M II 0 o /0% 0 o /0% 2 Fair 3 5 13.5 M II 0 o /5% 0 o /3% 1 Good 6 10.3 M II 3 o /18% 2 o /6% 1 Good 7 14.2 M II 0 o /0% 0 o /3% 0 Good 8 13.3 M III 12 o /12% 10 o /8% 0 Good 9 15.6 M IV 15 o /9% 13 o /3% 0 Good 10 12.0 M II 5 o /6% 4 o /5% 2 Fair 4 11 13.2 F II 0 o /8% 0 o /10% 2 Good 12 8.4 M II 13 o /17% 10 o /8% 0 Good 13 10.3 M II 8 o /4% 5 o /4% 0 Good 14 10.3 M II 3 o /10% 5 o /10% 0 Good 15 15.8 M II 0 o /0% 0 o /0% 0 Good 16 10.1 F II 5 o /5% 5 o /5% 0 Good 17 12.5 M I 5 o /10% 5 o /15% 0 Good CR: Closed reduction, M: Male, F: Female, S-H: Salter-Harris type, RS, Radial shortening, *1: Weakness of hand grip, 2: Deformity of radial inclination, 3, Wrist pain; 4, Decrease of range of motion.

소아에서요골원위골단판골절 227 고정술을시행하였다 (24 예 ). 본연구는이들중 1 년이상추시관찰되고엑스선및최종결과분석이완전한 1 군 6 예와 2 군 17 예, 총 23 예를대상으로하였다 (Table 1). 환아들의평균연령은 12.5 세 (8.4 15.8 세 ) 로남아가 20 예, 여아가 3 예였으며, Salter-Harris 1 형골절이 4 예 (17%), 2 형골절이 17 예 (74%), 3 형이 1 예 (4%), 4 형이 1 예 (4%) 였다. 수상원인은미끄러지면서손을짚고넘어진경우가 10 예, 철봉, 놀이터등높은곳에서낙상한경우가 6 예, 태권도, 롤러스케이트등으로인한스포츠손상이 6 예, 교통사고가 1 예였다. 손상의형태는수상당시모두가폐쇄성골절이었다. 수술시기는수상일로부터 1 일에서 7 일까지로평균 3.2 일이었고술후평균 3.1 년의추시관찰이시행되었다. 모든예에서술후완관절의전후면및측면방사선사진에서골단판의전이정도와골단판의경사도를측정하였다 (Fig. 1). 또한추시전후면및측면방사선사진을통해요골측경사, 수장측경사, 요골단축을건측과비교하 Fig. 1. Measurement of the epiphyseal angle and displacement of the growth plate of the distal radius on A-P and lateral radiographs. 였으며임상적기준으로운동범위제한, 동통, 파악력감소, 완관절의변형을관찰하였다. 최종결과는이러한방사선학적기준 9,10,20) 과임상적기준 17) 을근거로양호, 보통, 불량으로분류하였다 (Table 2). 통계적분석을위해서 SPSS 12.0 을사용하였다. 1, 2 군간의최종결과의판정은 Fisher's exact test 를사용하였으며두군간의술후및최종엑스선상에서의측정치들의통계학적분석은비모수적검정 (Wilcoxon Rank Sum Test) 을시행하였다. p 값이 0.05 이하인경우를통계적으로유의한것으로평가하였다. 결 1 군의평균연령은 11.7 세 (8.8 14.6 세 ) 로 Salter-Harris 1 형골절이 2 예, 2 형이 4 예였다. 평균 5.5 주동안석고붕대고정을시행하였으며전예에서합병증없이정상적인골단판의성장을보였다. 골단판의경사는도수정복전평균전후면 13 도, 측면 10 도에서도수정복후평균전후면 6 도, 측면 4 도를보였다. 골단판의전위는도수정복전평균전후면 42%, 측면 54% 에서도수정복후평균전후면 12%, 측면 10% 를보였고 (Table 1) 최종추시에서는정상측과거의비슷한모양을보였다. 척골변이도 2 mm 이내의차이를보였다 (Fig. 2). 1 군에서최종추시시의결과는양호가 5 예, 보통이 1 예였다. 2 군의평균연령은 12.7 세 (8.4 15.8 세 ) 로 Salter-Harris 1 형골절이 2 예, 2 형이 13 예, 3 형이 1 예, 4 형이 1 예였다. 평균 4.3 주의석고붕대고정을시행하였고 17 예중 16 예 (94%) 에서골단판의조기유합이나변형없이골단판의정상적인성장을보였다. 2 군에서최종추시시의결과는양호가 14 예, 보통이 2 예, 불량이 1 예였다. 합병증이없던 16 예에서골단판의경사는술전평균전후면 16 도, 측면 12 도에서술후평균전후면 5 도, 측면 4 도를보였다. 골단판의전위는술전평균전후면 62%, 측면 72% 에서술후평균전후면 7%, 측면 5% 를보였다 (Table 1). 최종추시에서이들은정상측과큰차이를보이지않았으며척골의 과 Table 2. Criteria for final results Criteria Good Fair Poor Radiologic criteria Difference* of radial inclination <5 o 5 10 o >11 o Difference* of dorsal tilting <5 o 5 10 o >11 o Radial shortening <3 mm 3 6 mm >6 mm Clinical criteria ROM Near normal Mild decreased Severe decreased Wrist pain No or slight Moderate Severe Weakness of grip strength No or slight Moderate Severe Wrist deformity No or slight Moderate Severe ROM: Range of motion, *affected vs. unaffected.

228 김휘택, 윤명수, 이종서, 최영준, 성윤재 Fig. 2. (A) A-P and lateral radiographs of an 8-year-old boy who sustained a Salter-Harris type II growth plate injury in the distal radius. (B) Closed reduction was achieved at the first attempt and a long arm cast was applied. Postoperatively, the epiphyseal angle was 12 o and the displacement was 30%. (C) Radiographs taken 5 years and 5 months after trauma show satisfactory results. This patient showed no clinical complications at the last follow up. 변이역시 2 mm 이내를보였다. 조기골단판폐쇄를보인 1 예는도수정복을 4 회시행한경우로최종추시에서 5 mm 의요골단축을보여골교제거술, 지방조직의이식, 요골절골술, 척골골단유합술, 요골연장술등을시행하여만족할만한결과를얻었다 (Fig. 3). 1, 2 군간의최종결과는통계학적으로유의한차이를보이지않았다 (Table 1). 또한, 조기골단판폐쇄의합병증이발생한 2 군 1 예를제외한 1 군 (6 예 ) 과 2 군 (16 예 ) 에서의술후및최종엑스선상에서의측정치들도통계학적으로유의한차이를보이지않았다 (Table 3). 고 원위요골골절의 75% 는 10 16 세사이에서발생하며이시기에골절이호발하는원인은빠른골성장으로인한골밀도의감소와관련이있다 4). 대부분의골절은전완부골절과마찬가지로손목을신전한상태로바닥을짚어발생한다. 이때골단판은섬유성관절낭, 건, 인대보다더약 찰 하므로견열또는전단력에의해골절이주로발생하게된다. Lee 등 11) 은요골원위골단판골절은대부분 Salter- Harris 1 형또는 2 형의골절로 7% 에서조기골단판폐쇄가일어났고이들의대부분은 Salter-Harris 2 형에서발생했다고하였다. 본연구에서도 Salter-Harris 1 형골절이 4 예 (17%), 2 형골절이 17 예 (74%) 로 1, 2 형골절이 23 예중 21 예 (91%) 를차지하였다. 전위된 Salter-Harris 1, 2 형골단판골절의경우원위골편은배측으로전위되는경우가많으며이때정복은골단판의추가손상을피하기위해매우부드럽게시행되어야하고과교정을막아야한다. 또한, 정복이힘든소수의제 2 형골절의경우약 50% 의단단접촉 (end to end apposition) 이되면반복된조작을피해야한다 11). Gandhi 등 7) 은성장잠재력이 2 년이상남은소아에서는정복이불완전하여도재형성이잘일어나므로반복적조작으로인한성장정지의위험을피해야하며수상후 10 일이경과하면불완전한정복상태를수용함이바람직하다고하였다. 드물지만, 골절부위에골막편, 인대, 정중신경이나요골동맥및

소아에서요골원위골단판골절 229 Fig. 3. (A) Radiographs of an 11-year-old boy who sustained a Salter-Harris type II growth plate injury in the distal radius. (B) Closed reduction was attempted 4 to 5 times and K-wires were used to maintain reduction. (C) Two years after injury, radiographs show 5 mm of radial shortening and a wrist deformity involving 15 of radial inclination and 15 o of volar tilting, due to central bar formation of the distal radial physis. This patient complained of poor grip strength. (D) Resection of the physeal bar, fat graft and corrective osteotomy of the distal radius were performed (A-P radiographs following surgery). (E) 2 years and 6 months after surgery, the radius again observed to be 5 mm shorter than the ulna. (F) Ulnar shortening through the growth plate was performed, with simultaneous epiphysiodesis of the ulna. (G) Final follow-up radiographs showed a satisfactory result. Table 3. Comparison of radiologic assessment between group I and group II AP Postoperation Lateral Last follow up angulation displacement angulation displacement Radial inclination (AP) Volar tilting (Lateral) Group I (6 cases) 6.0 o ±3.2 12.2%±10.0 4.0 o ±2.6 10.2%±8.8 21.7 o ±1.8 10.2 o ±1.2 Group II (16 cases) 5.1 o ±4.9 7.1%±5.5 4.0 o ±4.2 5.4%±3.9 22.0 o ±1.9 10.7 o ±1.4 p value 0.501 0.221 0.970 0.250 0.680 0.425 Patients with premature epiphyseal closure was excluded from this analysis (1 case in group II).

230 김휘택, 윤명수, 이종서, 최영준, 성윤재 정맥의개재가의심되는경우관혈적정복을시행해야하며, 경우에따라서 K- 강선을이용해내고정술을시행해야한다. 그러나이러한내고정핀에의한부분적인성장장애가발생할수도있으므로 K- 강선은골절의정복유지가불안정한경우에사용한다. 요골원위골단판골절은흔히도수정복후석고고정만으로치료가가능하고경과가양호하다 10). 본연구에서 1 년이상추시관찰된대상군수를보면 1 군의경우같은기간에치료한총 28 예중 6 예, 2 군의경우총 24 예중 17 예로수술적치료가시행된 2 군의수가더많았다. 이는골절의전위및종창이경하여응급실에서도수정복이시행된 1 군의경우대부분치료결과가양호하므로 1 년이상추시관찰된환자들의수가적다는것을암시하고있다. 그러나골단판의성장정지는골단판손상후즉시나타나는것이아니라 6 개월정도이후에나타나므로 1) 모든골단판손상은치료 1 년후까지추시관찰하는것이중요하다. 특히 Salter-Harris 5 형골절의경우는흔히성장정지가현저한후에야진단되는경우가많다. 원위요골이골단판손상의가장흔한부위임에도불구하고골절후골교의형성이나비정상적인성장은드물다 15). 조기골단판폐쇄는골단판의직접적인손상, 장기고정이나수술적인침습에의한골판단의허혈, 과다한반복적인도수정복에의한골단판의압박손상등에기인한다 5,8,11). Bragdon 5) 은반복된과다한도수정복은골단판의손상을더욱조장하며조기골단판폐쇄를야기한다고하였으며 Lee 등 11) 도전신마취하에도수정복이 2 회이상시행된 22 예중 6 예에서골단판의조기폐쇄가발생하였다고하였다. Horii 등 8) 도 2 예의원위요골의조기골단판폐쇄를보고하면서 K- 강선통과로인한골단판의손상을직접적인원인으로보고하였다. 본연구에서도골단판조기폐쇄를보인예에서는과다한도수정복의시도가원인이된것으로분석되었다. 전위된골편을도수정복한후약 10% 에서재전위가발생할수있다. 그러므로 1 주간격으로가골이생길때까지방사선사진촬영을통해추시관찰해야한다. 전위된골단판골절에대한도수정복후남은골절편의각형성및전위는성장기간이 2 년이상남아있는소아에서는대부분재형성이가능하다 6,7). Lee 등 11) 은골단판조기폐쇄가발생한대부분의경우는골절편의정복각도가만족스러웠고정복후전위도 30% 이내인경우였으며, 반대로정복후 30% 이상의전위를보인많은경우에서는이러한합병증없이만족스러운결과를보였다고하였다. 본연구에서도일차정복후전후면방사선사진상 30% 정도의전위를보이는경우 ( 증례 1) 가있었으나재형성이일어나서만족스러운결과를보였다. 수상당시손상의정도, 골절의유형, 연령등은골단판골절의예후에영향을줄수있는요소이다 9). 그러나수상당시손상의정도를정확히평가하기는매우어려우며대부분의경우환아의수상병력과골편의전위정도및종창의정도로평가할수있다. 그러나본연구에서와같이대상군중일차치료기관에서몇차례도수정복을시도한후정복이만족스럽지못하여전원된경우에서는특히초기손상정도를평가하기가힘들었다. 골절의유형또한예후에영향을줄수있는중요한인자이나본연구에서와같이대부분이 Salter-Harris 2 형인경우각골절유형간에통계학적평가를하기에무리가있었다. 성장판골절은일반적으로나이가어릴수록성장잠재력이높아서치료후양호한결과를보이는것으로알려져있다. 본연구의대상군은수상당시모두성장기간이 2 년이상남아있는경우였으며이들을나이에따라세군 (8 10, 11 13, 14 16 세 ) 으로나누어최종결과와분석해볼때서로간에통계학적유의성을찾지못하였다. 그러나이러한통계학적분석은향후많은수의대상군을확보한후재분석이필요할것으로생각된다. 조기골단판의폐쇄로인한주증상은손목의변형과동통, 마찰음, 파악력의저하, 손목의신전장애이며이의치료로는성장이완료될때까지의관찰, 골교의제거와지방이식, 골단유합술, 요골절골술, 척골단축술등이시도되고있다 8,11). Lee 등 11) 은골단판손상을입은 100 명의환아를성장완료때까지관찰한결과이들중 7 명에서골단판조기폐쇄로심각한증상을호소하였으며 4 mm 이상의요골단축을보인경우불만족스러운결과를보인다고하였다. 본연구에서도골단판조기폐쇄를보인증례에서 5 mm 의요골단축을보였으며불량한결과를나타내었다. Horii 등 8) 은조기골단판폐쇄환자의주증상인손목변형의치료로골교의제거와지방조직의이식을효과적인치료로제시하였다. 본연구에서도조기골단판폐쇄로손목의변형과동통을보인증례의경우골교제거술, 지방조직의이식, 요골절골술, 척골골단유합술, 요골연장술등을시행하였으며술후만족할만한결과를얻었다. 본연구의결과를보면도수정복후석고붕대고정을시행한군과도수정복및 K- 강선고정후석고붕대고정을시행한군모두만족할만한결과를얻었으며 K- 강선고정에따른골단판유합등의후유증은없었다. 골절정복후골단판의전위정도는대부분 30% 이내였으며최종엑스선상재형성능력에의해정상에가까운모양을보였다. 조기골단판폐쇄를보인예는여러번의과도한힘을가한도수정복에따른이차적골단판손상이있었을것으로짐작되었다. 이러한합병증을방지하기위해서는과도한힘의도수정복을피하고또한그시행횟수를줄이며

소아에서요골원위골단판골절 231 30% 정도의잔여전위는허용하여도될것으로생각되었다. 또한초기전위와부종이심하고정복이불안정한경우마취하에부드러운도수정복과함께경피적 K- 강선고정술을시행하는것은성장판손상의위험과재전위의위험성을줄이고잦은추시관찰을줄이기위해좋은치료방법이될수있다. 그러나마취의필요성으로그적응증을신중히판단해야하며또한강선의골단판통과에따른합병증의발생가능성도항상염두에두어야하겠다. 참고문헌 1) Abram LJ, Thompson GH: Deformity after premature closure of the distal radial physis following a torus fracture with a physeal compression injury. Report of a case. J Bone Joint Surg Am, 69: 1450-1453, 1987. 2) Aminian A, Schoenecker PL: Premature closure of the distal radial physis after fracture of the distal radial metaphysis. J Pediatr Orthop, 15: 495-498, 1995. 3) Arora A, Adedapo AO, Shaw DL: Unusual distal radial epiphyseal injury in a child. Injury, 30: 149-150, 1999. 4) Bailey DA, Wedge JH, McCulloch RG, Martin AD, Bernhardson SC: Epidemiology of fractures of the distal end of the radius in children as associated with growth. J Bone Joint Surg Am, 71: 1225-1231, 1989. 5) Bragdon RA: Fractures of the distal radial epiphysis. Clin Orthop Relat Res, 41: 59-63, 1965. 6) Friberg KS: Remodelling after distal forearm fractures in children. I. The effect of residual angulation on the spatial orientation of the epiphyseal plates. Acta Orthop Scand, 50: 537-546, 1979. 7) Gandhi RK, Wilson P, Mason Brown JJ, MacLeod W: Spontaneous correction of deformity following fractures of the forearm in children. Br J Surg, 50: 5-10, 1962. 8) Horii E, Tamura Y, Nakamura R, Miura T: Premature closure of the distal radial physis. J Hand Surg Br, 18: 11-16, 1993. 9) Kim JR, Pyo SH, Hwang BY: Results of treatment for epiphyseal injuries of the ankle in children. J Korean Fracture Soc, 13: 680-685, 2000. 10) Kim TS, Park YS, Kim DK, Cho JL: Conservative treatment of moderately displaced S-H type II injury in distal radius -a report of 5 cases-. J Korean Fracture Soc, 10: 718-725, 1997. 11) Lee BS, Esterhai JL Jr, Das M: Fracture of the distal radial epiphysis. Characteristics and surgical treatment of premature, post-traumatic epiphyseal closure. Clin Orthop Relat Res, 185: 90-96, 1984. 12) McLauchlan GJ, Cowan B, Annan IH, Robb JE: Management of completely displaced metaphyseal fractures of the distal radius in children. A prospective, randomized controlled trial. J Bone Joint Surg Br, 84: 413-417, 2002. 13) Mizuta T, Benson WM, Foster BK, Paterson DC, Morris LL: Statistical analysis of the incidence of physeal injuries. J Pediatr Orthop, 7: 518-523, 1987. 14) Peterson CA, Peterson HA: Analysis of the incidence of injuries ot the epiphyseal growth plate. J Trauma, 12: 275-281, 1972. 15) Perterson HA: Partial growth plate arrest and its treatment. J Pediatr Orthop, 4: 246-258, 1984. 16) Ray TD, Tessler RH, Dell PC: Traumatic ulnar physeal arrest after distal forearm fractures in children. J Pediatr Orthop, 16: 195-200, 1996. 17) Rogers LF: The radiography of epiphyseal injuries. Radiology, 96: 289-299, 1970. 18) Salter RB, Harris WR: Injuries involving the epiphyseal plate. J Bone Joint Surg Am, 45: 587-622, 1963. 19) Sarmiento A, Pratt GW, Berry NC, Sinclair WF: Colles' fractures. Functional bracing in supination. J Bone Joint Surg Am, 57: 311-317, 1975. 20) Schuind FA, Linscheid RL, An KN, Chao EY: A normal data base of posteroanterior roentgenographic measurements of the wrist. J Bone Joint Surg Am, 74: 1418-1429, 1992. 21) Tang CW, Kay RM, Skaggs DL: Growth arrest of the distal radius following a metaphyseal fracture: case report and review of the literature. J Pediatr Orthop B, 11: 89-92, 2002. 22) Valverde JA, Albiñana J, Certucha JA: Early posttraumatic physeal arrest in distal radius after a compression injury. J Pediatr Orthop B, 5: 57-60, 1996.