Review Question - QID 322

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Distal Radius Fractures Techniques ORIF QID: 322 (OBQ06.136)

QID 322 (Type "322" in App Search)

A 25-year-old female falls from her horse and injures her left wrist. There are no open wounds and the hand is neurovascularly intact. Radiographs are provided in Figures A-C. Which of the following will best achieve anatomic reduction, restore function, and prevent future degenerative changes of the wrist?

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Long arm cast above the elbow for 6 weeks

5/1474

Long arm cast for 3 weeks followed by a short arm cast for 3 additional weeks

11/1474

Closed reduction and external fixation

13/1474

Closed reduction and percutaneous pinning

24/1474

Open reduction and internal fixation

96%

1410/1474

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The radiographs demonstrate an intra-articular distal radius fracture with dorsal angulation. Most importantly, there is a large dorsal articular fragment. Open reduction of this fragment is best acheived through an open approach. The choice of dorsal vs. volar approach is debatable, but most importantly the articular surface, radial height, and volar tilt must be reduced anatomically.

Yu et al reviewed 104 distal radius fractures treated with either dorsal or volar plating. There was no difference in the rate of tendon irritation or rupture between the groups. Volar plating was associated with significantly more neuropathic pain complications.

Illustrations A and B demonstrate the open reduction and internal fixation of this fracture with a dorsal plate.

ILLUSTRATIONS: