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CASE REPORT

Northeast Health Wangaratta

Yup perfect. Exactly what I’d do. The majority above that answered volar in the approach question above perplex me? How can you reduce and fix what you cannot see and what is being pushing away by your volar based fixation? I don’t do it often, maybe once a year, but that kind of dorsal Barton’s fra...cture where you have dorsal joint subluxation is one where you just have to admit defeat from a volar approach and accept you need to go dorsal and that the hardware will need to come out at a second procedure. That’s clearly explained pre op to all my patients I’m going dorsal on. Great work. Love it!

In there lies the crux of what we all do in practice. Weigh the pro/con of every trick in our book and factor that into the patient's health profile and expectations. While we have to respect the personality of the fracture as Joe Schatzker drilled into me we also have very important patient and hea...lth care system factors. All in there is just no good cookbook for success because the fracture patterns and patients vary so much that any study we do is underpowered. We will continue to have success and failure with all techniques. Since Abraham Colles one thing is true about distal radius fractures, less is often more. Deformity does not dictate function.

You have a nice case there, but as we cannot be there to interact with the patient preoperatively or intraoperatively, we cannot adequately judge what is done. As truth and good remain relative concepts, many of us would have done other things ranging from nonoperative treatment to plating to ex fi...x. It doesn't necessarily mean that any of us or you are right or wrong in that regard, and this is where the art of medicine comes into play. As someone who even uses K-wires along with minifrag plates or even volar plates on occasion, these are all tools in our toolbox and we shouldn't rule any out as irrelevant. Just because this surgeon utilized the plates here doesn't necessarily mean it is incorrect - the outcome may be perfectly fine and the patient may be going along with life without any issues. The flexion of the reduction is likely the etiology of (or helps to worsen) the new-onset nerve issues. Reduction of the fx without a splint or cast pushing on it should resolve this over time, which is likely why you noted improved nerve function after K-wire placement. I see this not infrequently with overeager residents trying to place a nice mold.

Perfectly done Do you scope any fracture? Do you perform arthrotomy to check reduction? Thanks for sharing

Thank you everyone for your comments and feedback, I chose the case as I felt it could go in any of many directions, and thought it would be good to start the conversations that are unfolding already. Closed vs. open management, approach, fixation (if any!), post operative regime. Appreciate the tho...ughts and shared wisdom.

PMID: 20194348

J Bone Joint Surg Am. 2010 Mar;92 Suppl 1 Pt 1:96-106.

Operative management of distal radial fractures with 2.4-millimeter locking plates: a multicenter prospective case series. Surgical technique.

J Bone Joint Surg Am. 2010 Mar

Jesse B Jupiter | M Marent-Huber | LCP Study Group

PMID: 17768207

J Bone Joint Surg Am. 2007 Sep;89(9):2051-62.

Management of distal radial fractures.

J Bone Joint Surg Am. 2007 Sep

Neal C Chen | Jesse B Jupiter

Distal Radius Fractures

PMID: 29780618 EFORT Open Rev. 2018 Apr;3(4):114-120. Epub 2018 Apr 26.

FREE PDF

Closed reduction of distal radius fractures: a systematic review and meta-analysis.

ABSTRACT
- Distal radius fractures (DRF) are a common injury, especially in the elderly.Displaced fractures can be reduced by closed reduction through several techniques, two of which are compared in this systematic review and meta-analysis.Closed reduction by finger-trap traction (FTT) seems to offer better correction of radial shortening. Additionally, there may be less pain and fewer complications associated with this technique.Closed reduction by manual traction seems to offer better correction of the dorsal tilt.Further research is needed to fully determine the optimal method of closed reduction. Cite this article: EFORT Open Rev 2018;3:114-120.DOI: 10.1302/2058-5241.3.170063.

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