(case submitted August 22, 2007)
The patient is a 75 YO woman with Type II diabetes. (Incidentally, she is also a famous cardiologist colleague's mother, and a orthopaedic surgeon's grandmother, so of course, the case did not go as planned.) She originally fractured this radius more than 20 years earlier and developed a malunion. She again sustained a fracture of her distal radius and ulna 8 months previously, and presented to me. I treated her with a Synthes volar plate to radius and a Synthes 2.0 mm plate to the distal ulna, with suture of TFC complex to the plate (for a picture of the technique, see Case 13, page 3). At her last visit, 6 months after surgery, she had full mobility, no pain, and the patient was very satisfied about the treatment. However, the xrays suggested that she might have a nonunion. Now, 8 months after her surgery, she fell again, with pain and deformity.
(1) Do you think the fracture had healed? Can you be sure?
(2) What would be your first option?
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