Distal Radius Fractures: Let Me Show You What Trauma Surgeons Do! - PowerPoint PPT Presentation

Distal Radius Fractures: Let Me Show You What Trauma Surgeons Do! Lisa K. Cannada MD

Disclosures • No pertinent disclosures • Member: – AAOS Board of Directors – MAOA Board of Directors – OTA Committee Member

Etiology

Etiology

Etiology

Who Did This?

Trauma or Hand 26%

Trauma or Hand

Trauma or Hand

Trauma or Hand

Trauma or Hand

Trauma or Hand

Treatment Goals & Considerations

Factors to Consider • Age • Dominance • Demand • Additional Injuries • Medical co-morbidities

What Does This Mean? 4685 11/22/17

Treatment Options • Nonoperative • Percutaneous pinning • External fixation • ORIF • Combination • Adjuncts

Before You Start

Treatment • Kwire fixation – Acceptable CR – Give subchondral support – May unload joint with Ex Fix

External Fixation • Don’t throw away the ex fix! • Fractures with metaphyseal comminution • Open fractures • Polytrauma patient • In combination with other treatments

Pin Placement Proximally: Open incision Between ECRL and Identify SRN ECRB

Ex Fix

Ex Fix

Case Example

“Regular” Plating

“Regular” Plating

Know Your Plate

Volar Approach • Identify landmarks • Find FCR • Can extend into carpal tunnel if necessary

Volar Approach • Incise FCR volar sheath • Identify radial artery

Volar Approach • Retract FCR ulnarly • Then incise FCR dorsal sheath • Pronator quadratus identified

Volar Approach • Incise pronator quadratus • Avoid radiocarpal joint arthrotomy Tip: Can release brachioradialis for styloid exposure

Volar Approach

Getting the reduction…

Reduce & Hold Before Plating…

Radiographic Evaluation • Pronated Oblique View • Dorsal Tangential View

Dorsal Plating

Always Evaluate the DRUJ

Always be prepared…

Surprise!!!

Trauma or Hand 20%

Trauma or Hand

Trauma or Hand 59% , 23%

Trauma or Hand 59%

Summary • There is no gold standard for treatment or fixation • Maintain many “tools” in your armamentarium

Thank You! Lcannada@slu.edu