Surgical Discussion

I figured the easiest place to start would be in reducing the volar intermediate and ulnar columns give this block of intact joint surface could be captured and manipulated as a single unit. This was done with a juxta articular distal radial plate with three subchondral screws, engaging only this fragment piece. The length of the screws was deliberately kept short, so as to not interfere with a secondary dorsal fragment reduction. Reduction of this joint surface fragment was done through positioning of the plate, and reduction of the plate to the distal radial diaphysis achieving neutralization of the dorsal annulation. It became apparent at this point that the radial styloid piece was freely independent, and not reducible in combination with the volar intermediate column. Given real estate limitations on the volar side, fragment specific fixation of the radial styloid through the dorsal approach (together with fixation of the other dorsal fragments) was decided. Incision over the joint centred on Listers. The third extensor compartment was left in tact. Instead, I opened the second compartment to identify the radial styloid fracture and its dorsal aspect. This was reduced and fixed with the k-wire before radial styloid plating along the dorsal radial aspect without opening the first extensor compartment. Then moving to the ulnar side of listers, I open the fourth compartment with EDC/EI and elevated to expose the ulnar aspect of listers fragment, along with the dorsal lunate fragment. These were reduced and fixation was achieved through simple buttress plating without screw fixation. Suture reinforcement of the fragments to the plate through the dorsal capsule and the dorsal radiocarpal ligament along with the distal radioulnar ligament was achieved.