|
Year |
2006 |
|---|---|
|
Question Number |
136 |
|
Category |
Hand |
Question
Figures 47a and 47b show the radiographs of a 22-year-old man who sustained a wrist fracture. CT scans obtained after closed reduction and splinting are shown in Figures 47c and 47d. Treatment should now include
1- Repeat closed reduction and casting for 6 weeks.
2- Closed reduction and percutaneous pin insertion.
3- Closed reduction and application of external fixation.
4- Open reduction and internal fixation through a dorsal approach.
5- Open reduction and internal fixation through a volar approach.
Figures
Answer (click for answer)
Answer: 4
The Figures show a displaced comminuted intra-articular distal radius fracture. Intra-articular fractures require fixation that provides absolute stability and anatomic reduction. To achieve this open reduction and internal fixation is required. CR and casting, CRPP, and CR and ex-fix do not allow for anatomic reduction of the articular surface and only provide relative stability. That leaves ORIF either through a volar approach or dorsal. From the films, the comminution is dorsal. It would be very difficult to capture those pieces with a screw from an anterior plate. A posterior plate buttressing those fragments would be better. Therefore the best answer is ORIF through a dorsal approach.
Reference:
Attachments:
OITE 2006 figure 47a.jpg (image/jpeg)
OITE 2006 figure 47b.jpg (image/jpeg)
OITE 2006 figure 47d.jpg (image/jpeg)
OITE 2006 figure 47c.jpg (image/jpeg)
