Clinical Details

Clinical and radiological findings:  This distal radius fracture belongs to a 67-year-old female following a simple trip and fall. On initial plain film imaging (at least based on the lateral projection) you could be convinced that this is a normal dorsally displaced Colle's type fracture. However careful evaluation of the AP film demonstrates a discontinuity between the scaphoid and lunate facets. The exact degree of comminution of the articular surface however was not fully appreciated until completion of a CT scan as part of our standard preoperative planning. Here on the two 3D reconstructions provided one can appreciate a) in the palmar view a complete dissociation between the two joints facets and b) how the lunate facet has a secondary coronal split dividing it into a palmar and dorsal components. The operation took place supine with the arm prepared on a secondary arm table to the side of the main operating table. A standard Henry’s approach over FCR was utilized. I reconstructed both the radial scaphoid facet and the ulnar lunate facet as two individual blocks before reducing them together to the proximal radial metaphysis. This reduction was held with multiple K wires before placing a two column distal radial locking plate. You can see by screw placement in the locking plate that each facet block was fixed individually - each with three locking screws. The middle screw hole was not utilized as this sat directly in the fracture zone between both fragment constellations.