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PRESENTATION
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POLLS
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OUTCOMES
3
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VIDEOS
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EVIDENCE
27
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Comments
28
CASE DESCRIPTION
AGE 72 / Male
CC Left wrist pain
HPI A 72-year-old male, RHD, presents to the ER after falling from a standing position onto his left wrist. The patient had immediate pain and was unable to use his hand without discomfort. He denies pain in any other extremity. No head trauma or loss of consciousness.
PMH Diabetes
PE A focused physical exam of the LUE reveals intact skin over the wrist. An obvious wrist deformity and swelling are present. Tenderness to palpation is present over the wrist. Sensation is intact to light touch in all peripheral nerve distributions. Motor function is intact distally. Peripheral pulses are present and palpable.
Pre-procedure IMAGES:
https://upload.orthobullets.com/cases/102014/aa93134a-e316-493f-84f0-df2086ab6722_screenshot_2022-03-01_141930.jpg https://upload.orthobullets.com/cases/102014/99597711-9338-4971-bb2a-053cea00925c_screenshot_2022-03-01_141953.jpg https://upload.orthobullets.com/cases/102014/a11a4d28-bf61-4e06-ba64-a9b5bd3409e4_screenshot_2022-06-12_135820.jpg https://upload.orthobullets.com/cases/102014/bf4b6be8-655b-4654-b887-5fe28cb777cd_screenshot_2022-06-12_135851.jpg https://upload.orthobullets.com/cases/102014/2bef8c43-d721-4e13-884f-f19beda7eef6_screenshot_2022-06-12_135908.jpg
POLLS
OB Community
1) In addition to plain radiographs, would you obtain any further imaging to guide your treatment?
Other
2) Would you use a classification system to guide management of this injury?
Other
3) What would be your first step in management?
Other
4) How would you manage this injury?
Other
5) If you choose Operative management, would you perform a provisional closed reduction prior to surgery?
Other
6) If you choose Operative management, considering the patient presented to the ER at 2 PM on a weekday on the day of injury, what would be your time frame to take him to surgery and where would you do it?
Other
7) If you choose Operative management, what surgical technique would you use?
Other
8) If you choose Open reduction and internal fixation (ORIF), would you use any regional anesthesia?
Other
9) If you choose Open reduction and interal fixation (ORIF), what approach would you use?
Other
10) If you choose Operative management, would you also perform a carpal tunnel release at the time of surgery?
Other
11) If you choose Operative management and attained the construct shown, when would you begin range of motion exercises post-operatively?
Other
12) If you choose Operative management and attained the construct shown, when would you allow weight-bearing post-operatively?
Other
CASE OUTCOMES
PROCEDURE 1: Open treatment of intraarticular distal radial fracture or epiphyseal separation with internal fixation of three or more fragments; CPT 25609
DOP: 2/23/2022
Intra-procedure P1
https://upload.orthobullets.com/cases/102014/6d377e96-e40e-4ab2-84b4-71ac82f4f0a2_screenshot_2022-03-01_142114.jpg
Intra-procedure P1
https://upload.orthobullets.com/cases/102014/e50e5734-5f15-4b04-b076-6e7e9ac1442a_screenshot_2022-03-01_142039.jpg https://upload.orthobullets.com/cases/102014/bb9871ca-e338-4498-a984-c4373f4eec75_screenshot_2022-03-01_142053.jpg
VIDEOS & PODCASTS (4)
EVIDENCE (27)
EXPERT COMMENTS