AP view radiograph of an intraarticular distal radius fracture'

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AP view radiograph of an intraarticular distal
radius fracture.
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Lateral view radiograph of an intraarticular
distal radius fracture.
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2mc
BARE AREA
EPL
The bare area of the radius is identified.
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A 5-mm incision is made over the bare area of the
radius.
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A fine clamp is used to dissect gently down to
bone to avoid damage to neurologic and vascular
structures.
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Once the clamp is on bone, two Ragnell retractors
are used to retract the tendons to either side of
the radius. A small key elevator is used to clean
an area of bone for the pin cannulas.
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BONE
Bone is visualized at the base of the incision,
confirming that there is no danger to the
superficial radial nerve or other structures.
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A cannula system is used for drilling and
half-pin placement.
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After the hole is drilled, the inner cannula is
removed and the pin is placed through the outer
cannula.
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To determine the location of the second pin, a
pin clamp is used.
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After both proximal pins are placed, fluoroscopy
confirms the appropriate length.
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The distal pins are placed into the second
metacarpal. The mark on the metacarpal
indicates the first pin, placed near the base of
the second metacarpal. The second pin is placed
distal to this using a pin clamp as a guide to
its location.
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The forearm after the two sets of pins are
placed. The connecting rods are applied to the
frame, then the initial reduction is performed.
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The initial reduction is performed by flexing the
elbow, slightly supinating the forearm and
pulling gentle traction.
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The frame is then tightened in this position
and radiographs are obtained with 10 degrees
of angulation in each direction.
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A small dorsal incision can be made for the
percutaneous reduction of impacted fragments as
well as for bone grafting.
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A curved osteotome is used to elevate an
impacted ulnar-sided fragment.
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A curved osteotome is used to elevate an
impacted ulnar-sided fragment.
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While the fragment is being held in place, a
K-wire can be driven across from the styloid
into the fragment, holding it in a reduced
position.
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Allograft bone or other bone graft substitute may
be introduced into the dorsal defect at this
point.
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Clinical picture of the external fixator and
percutaneous pin in place. It is important at
this time to test that full flexion of the MP and
IP joints is possible, as well as motion of the
thumb, confirming that none of the tendons are
impinged and that there is not overdistraction of
the carpus.
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AP radiograph after fixation.