Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the left arm extended on a hand table to facilitate access to the volar aspect of the wrist.

Anatomical surgical approach:  A modified Henry approach was utilized, involving an incision along the flexor carpi radialis tendon. Dissection proceeded between the flexor carpi radialis and the radial artery, with careful retraction of the flexor tendons and protection of the median nerve. The pronator quadratus muscle was elevated subperiosteally to expose the distal radius.

Intraoperatively, a transverse osteotomy was performed at the site of deformity using an osteotome. Provisional fixation was achieved with Kirschner wires, allowing for realignment of the distal fragment. A volar locking plate was then applied distally to secure the reduction. The dorsal defect was filled with an autologous iliac crest bone graft to support bone healing and restore radial length.

Postoperative protocol:   Postoperatively, the patient was immobilized in a volar splint for two weeks, followed by initiation of range of motion exercises. Weight-bearing activities were restricted for six weeks to allow for graft incorporation and fracture healing.

Follow up:   Not specified.

Orthopaedic implants used:   Volar locking plate, Kirschner wires, autologous iliac crest bone graft.