Case Study: Distal Radius Plating performed
to a 77-year-old female patient
The distal radius is a bone in the forearm. The distal end of the radius, which is the larger of the two bones in the area, is the portion that juts out toward the wrist. As a result, when the radius bone close to the wrist fractures, a distal radius fracture is recognized.
Through secure fixation, plating provides immediate repair of the distal radius. The construct’s stability promotes more predictable healing of the fracture, reducing the amount of time the wrist must be immobilized.
Patient has been in our office for about a week complaining of left wrist pain. The discomfort is mildly felt. Aching is how the patient describes the pain. The persistent agony makes it difficult to sleep.
The discomfort is accompanied by bruising, swelling, numbness, tingling, and problems with hand function. Nothing, according to the patient, makes it worse. The patient did not specify what is best in her case.
Patient brought along her copy of CT and reviewed it. We found out that she has comminuted distal radius fracture with intraarticular extension and ulnar styloid fracture. We discussed treatment for patient diagnosis, which included: living with the extremity as it is, and surgical options.
We also discussed the nature and purpose of the treatment options along with the expected risks and benefits. The patient has expressed a desire to proceed with surgery, and I think that is a reasonable option.
I educated the patient regarding the inherent and unavoidable risks which include, but are not limited to: anesthesia, infection, damage to nerves and blood vessels, blood loss, wrist stiffness and pain, blood clots, and even death were discussed at length.
We also talked about the possibility of not being able to return to prior activities, the need for future surgery, and complex regional pain syndrome. The patient also understands there is a long rehabilitative process that typically follows the surgical procedure.
We talked about the possibility of not being able to alleviate all of the discomfort. Also, I explained there is no guarantee all the function and strength will return.
The patient also understands the risks of failure to heal. The patient understands implants will be utilized during this surgery. The patient expressed understanding of these risks and has elected to proceed with surgery.
The patient was taken to the operating room where she was placed on a well-padded operating table. General anesthesia was Induced.
Tourniquet was applied on the left upper extremity. The left upper extremity was prepped and draped aseptically in the usual fashion. A time-out was called. Preoperative antibiotic was given.
Tourniquet was inflated to 225 mmHg. Incision was given along the tendon of flexor carpi radialis. The anterior sheath of flexor carpi radialis was incised along the incision.
Flexor carpi radialis was retracted medially along with the median nerve and other tendons. The posterior sheath of the flexor carpi radialis was incised to expose the pronator quadratus tendon.
The pronator quadratus tendon was raised from the radial border with Bovie. The fracture site was opened and washed. There were comminuted fragments along with intra articular fragments. They were reduced.
Plate was put onto the volar aspect of the radius and held with olive wire. Reduction was checked on the C-arm and found to be acceptable. The plate was fixed distally using multiple locking screws.
First, a cortical screw was used to compress the fragment. The cortical screw was rejected and changed with a locking screw. Proximally, the plate was fixed with one cortical screw. The reduction was again checked and found to be acceptable in AP and lateral views.
Final fixation of the plate was performed using a combination of locking and nonlocking screws. There was distal radioulnar dissociation, which was held together and fixed with K-wires from radius and ulna x2. Final pictures were taken and saved.
The wound was thoroughly washed and closure was done in layers using 3-0 Vicryl and 4-0 Monocryl. Dressing was done with Xeroform and 4×4 Webril. Long arm splint was applied.
Ace wrap was used to put the splint. The patient was put in a shoulder sling and moved to recovery after extubation in stable condition.
After a week of seeing patients, he has been improving with regards to pain and swelling. He is limping and has been using crutches for ambulation. Denies fever, chills, reinjury. After two weeks post-surgery the incisions are healing well, without evidence of drainage, erythema or warmth.
There is a full range of motion without discomfort. We have decided to do formal physical therapy as well as a home exercise program for rehabilitation of the knee.
Patients regularly followed an office visit every 3-4 weeks. Patient did well after the surgery and continued physical therapy.
Disclaimer – Patient’s name, age, sex, dates, events have been changed or modified to protect patient privacy.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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