Clinical Details

Clinical and radiological findings:  This is a 47-year-old male who was involved in a motor vehicle accident. Amongst his various injuries so was this distal radius fracture/diclocation as identified in his trauma scan. Unfortunately we don’t have any plain film imaging of the wrist - only these reconstructions from the CT trauma series are available for pre-operative evaluation. The operation was a done supine with the arm on a small arm table to the side of the main operating table. A standard Henry’s approach over the FCR was utilized. Despite a complete mobilization of pronator quadratus and debridement of the fracture itself, the palmer fragment was incredibly stubborn to reduce due to the subluxation of the carpups. I employed a linear retractor with 2 K-wires to help reduce the fragment to it’s complete length restoring the continuity of the articular surface and reduce the RCJ. Whilst reduction was being maintained by the linear retractor i then temporarily fixed the reduction with the two K wires brought in from the radial styloid. Subsequently the fracture was definitively fixed with a two column distal radial locking plate. The radius plate provided excellent buttressing of this palmar fragment and held excellent joint congruity.