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Distal Radius Fractures
Posted: Oct 25 2020 #(C101603)
A

Distal Radius Malunion in 63F

HPI

A 63-year-old female who presents to the office for evaluation of left wrist deformity. The patient sustained a distal radius fracture 12 weeks ago at the start of the COVID pandemic. She was initially seen at an outside urgent care and splinted in situ. Surgery was recommended at that time, however, she refused given the pandemic. Risks of malunion and functional deficits were discussed with the patient at that time, she continued to refuse despite the less than acceptable position of her fracture. After radiographic healing was identified, immobilization was discontinued and the patient was pain-free. As time went on, contrary to what she previously thought, she was unable to tolerate the deformity and decreased range of motion and re-presented for evaluation.

PMH

PE

Focused exam of the left upper extremity demonstrates an obvious deformity to the distal radius. She has no tenderness to palpation about the wrist. Motor grossly intact as demonstrated by the cardinal hand motions. Sensation is intact to all distributions of the hand. Radial pulse palpable. Active range of motion from 105 degrees of wrist extension to 5 degrees short of neutral.

Poll
1 of 9
1. In addition to the plain film radiographs, would you obtain any additional imaging to guide management?
No - current radiographs are sufficient
52%
609/1166
Yes - additional radiographic views (XR)
1%
21/1166
Yes - CT scan of the wrist (CT)
37%
435/1166
Yes - MRI scan of the wrist (MRI)
1%
18/1166
Yes - CT + XR
3%
41/1166
Yes - MRI + XR
0%
5/1166
Yes - MRI + CT
1%
21/1166
Yes - MRI + CT + XR
0%
2/1166
Outside my area of expertise - best if don't vote
1%
14/1166
2. How would you manage this injury?
Nonoperative
6%
76/1155
Operative
91%
1062/1155
Outside my area of expertise - best if I do not vote
1%
17/1155
3. If you choose Operative management, what approach would you utilize?
I would not choose Operative management
0%
7/1147
Volar
59%
677/1147
Dorsal
24%
281/1147
Radial
1%
17/1147
Dorsal + Volar
12%
138/1147
Other
0%
2/1147
Outside my area of expertise - best if I don't vote
2%
25/1147
4. If you choose Operative management, what type of osteotomy would you perform on the radius?
I would not choose Operative management
0%
6/1126
Dorsal opening wedge
60%
678/1126
Volar closing wedge
31%
352/1126
Sliding
2%
30/1126
Other
1%
22/1126
Outside my area of expertise - best if I don't vote
3%
38/1126
5. If you choose to perform a Dorsal opening wedge osteotomy of the radius, what type of fixation would you utilize?
I would not perform a Dorsal opening wedge osteotomy of the radius
3%
34/1076
K-wires only
1%
19/1076
Screws only
0%
2/1076
Plate and screws
91%
984/1076
External fixator (ExFix)
1%
12/1076
ExFix + K-wires
0%
6/1076
Outside my area of expertise - best if I don't vote
1%
19/1076
6. If you choose to perform a Dorsal opening wedge osteotomy of the radius, would you also perform a concomitant ulnar osteotomy?
I would not perform a Dorsal opening wedge osteotomy of the radius
3%
37/1064
No
75%
804/1064
Yes
18%
199/1064
Outside my area of expertise - best if I don't vote
2%
24/1064
7. If you choose to perform a Dorsal opening wedge osteotomy of the radius, would you plan to use bone graft?
I would not perform a Dorsal opening wedge osteotomy of the radius
1%
19/1059
No - I would not use bone graft
15%
161/1059
Yes - allograft
28%
307/1059
Yes - autograft
46%
495/1059
Yes - autograft + allograft
5%
61/1059
Outside my area of expertise - best if I don't vote
1%
16/1059
8. If you choose operative management, would you perform a prophylactic carpal tunnel release (CTR)?
I would not perform Operative Management
0%
5/1031
Yes - I would do a prophylactic CTR
27%
283/1031
No - I would not do a prophylactic CTR
70%
723/1031
Outside my area of expertise - best if I don't vote
1%
20/1031
9. If you choose to perform a Dorsal opening wedge osteotomy of the radius and attained the construct shown below, how long would you immobilize the patient?
I would not perform a Dorsal opening wedge osteotomy of the radius
1%
14/1026
1-2 weeks
16%
168/1026
3-4 weeks
26%
274/1026
5-6 weeks
45%
463/1026
7-12 weeks
8%
91/1026
>12 weeks
0%
6/1026
Outside my area of expertise - best if I don't vote
0%
10/1026
PROCEDURE #1

Dorsal opening wedge osteotomy of the radius; internal fixation

Intra-procedure P1
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