Surgical and Radiologic Anatomy

, Volume 33, Issue 8, pp 683–687 | Cite as

Anatomical landmarks in the paediatric distal radius: a new method for measuring epiphyseal height

  • Nima Heidari
  • Robert Eberl
  • Sebastian Wiklicky
  • Katrina Evers
  • Annelie M. Weinberg
Original Article



Elastic stable intramedullary nailing for fixation of paediatric forearm fractures has become the preferred method of osteosynthesis. The aim of the study was to develop a method for finding the correct entry point in the distal radius of children of all ages as a distance from the radial styloid, a landmark which is readily palpable at the wrist.


MRI scans of the wrist in 19 children aged 2–7 years (mean 5) were reviewed. We noted that the proximal edges of the ossific nucleus of capitate and the tip of the radial styloid were at the same vertical height from the physis. This allowed us to review 519 wrist radiographs of children aged 2–14 years (mean 7.98) to measure the epiphyseal height, as the radial styloid does not ossify until the age of 14 years.


The epiphyseal height had a mean of 16.67 mm (13–21 mm). The epiphyseal height in boys was greater than the girls by a mean of 1.2 mm (p < 0.0005).


For the absolute safe distance, we recommend an insertion site 40 mm proximal to the tip of the radial styloid, which is safe in all children with an open distal radial physis. This simple and reproducible method allows the identification of the insertion site for the nail with only the minimal use of imaging.


Distal radius Distal radius epiphysis Forearm fractures Intramedullary nailing Elastic nailing forearm fractures Image intensifier 


Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Barry M, Paterson JM (2004) A flexible intramedullary nails for fractures in children. J Bone Joint Surg Br 86:947–953PubMedCrossRefGoogle Scholar
  2. 2.
    Garg NK, Ballal MS, Malek IA, Webster RA, Bruce CE (2008) Use of elastic stable intramedullary nailing for treating unstable forearm fractures in children. J Trauma 65:109–115PubMedCrossRefGoogle Scholar
  3. 3.
    Hedstrom EM, Svensson O, Bergstrom U, Michno P (2010) Epidemiology of fractures in children and adolescents. Acta Orthop 81:148–153PubMedCrossRefGoogle Scholar
  4. 4.
    Kapoor V, Theruvil B, Edwards SE, Taylor GR, Clarke NM, Uglow MG (2005) Flexible intramedullary nailing of displaced diaphyseal forearm fractures in children. Injury 36:1221–1225PubMedCrossRefGoogle Scholar
  5. 5.
    Kraus R, Meyer C, Heiss C, Stahl JP, Schnettler R (2007) Intraoperative radiation exposure in elastic stable intramedullary nailing (ESIN) during the growth period. Observations in 162 long-bone shaft fractures. Unfallchirurg 110:28–32PubMedCrossRefGoogle Scholar
  6. 6.
    Kraus R, Pavlidis T, Szalay G, Meyer C, Schnettler R (2001) Elastic stable intramedullary nailing (ESIN) in pediatric forearm shaft fractures: intraoperative image intensifier times. Z Orthop Unfall 145:195–198CrossRefGoogle Scholar
  7. 7.
    Kraus R, Schiefer U, Schafer C, Meyer C, Schnettler R (2008) Elastic stable intramedullary nailing in paediatric femur and lower leg shaft fractures: intraoperative radiation load. J Pediatr Orthop 28:14–16PubMedCrossRefGoogle Scholar
  8. 8.
    Lascombes P (2010) Flexible intramedullary nailing in children: The Nancy University Manual. SpringerGoogle Scholar
  9. 9.
    Lascombes P, Prevot J, Ligier JN, Metaizeau JP, Poncelet T (1990) Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. J Pediatr Orthop 10:167–171PubMedGoogle Scholar
  10. 10.
    McLean C, Adlington H, Houshian S (2007) Paediatric forearm refractures with retained plates managed with flexible intramedullary nails. Injury 38:926–930PubMedCrossRefGoogle Scholar
  11. 11.
    Oberle M, Schlickewei W (2005) Elastic-stable-intramedullary nailing for forearm fractures in children using TENS. Unfallchirurg 108:235–237PubMedCrossRefGoogle Scholar
  12. 12.
    Reinhardt KR, Feldman DS, Green DW, Sala DA, Widmann RF, Scher DM (2008) Comparison of intramedullary nailing to plating for both-bone forearm fractures in older children. J Pediatr Orthop 28:403–409PubMedCrossRefGoogle Scholar
  13. 13.
    Richter D, Ostermann PA, Ekkernkamp A, Muhr G, Hahn MP (1998) Elastic intramedullary nailing: a minimally invasive concept in the treatment of unstable forearm fractures in children. J Pediatr Orthop 18:457–461PubMedCrossRefGoogle Scholar
  14. 14.
    Schmittenbecher PP (2005) State-of-the-art treatment of forearm shaft fractures. Injury 36(Suppl 1):A25–A34PubMedCrossRefGoogle Scholar
  15. 15.
    Van der Reis WL, Otsuka NY, Moroz P, Mah J (1998) Intramedullary nailing versus plate fixation for unstable forearm fractures in children. J Pediatr Orthop 18:9–13PubMedCrossRefGoogle Scholar
  16. 16.
    Weinberg AM, Amerstorfer F, Fischerauer EE, Pearce S, Schmidt B (2009) Paediatric diaphyseal forearm refractures after greenstick fractures: operative management with ESIN. Injury 40:414–417PubMedCrossRefGoogle Scholar
  17. 17.
    Weinberg AM, Castellani C, Amerstorfer F (2008) Elastic stable intramedullary nailing (ESIN) of forearm fractures. Oper Orthop Traumatol 20:285–296PubMedCrossRefGoogle Scholar
  18. 18.
    Weinberg AM, Pietsch IT, Helm MB, Hesselbach J, Tscherne H (2000) A new kinematic model of pro- and supination of the human forearm. J Biomech 33:487–491PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Nima Heidari
    • 1
  • Robert Eberl
    • 1
  • Sebastian Wiklicky
    • 1
  • Katrina Evers
    • 1
  • Annelie M. Weinberg
    • 1
  1. 1.Department of Paediatric and Adolescent SurgeryLandeskrankenhaus, Medical University GrazGrazAustria

Personalised recommendations