David Nelson , MD
Private Practice, San Francisco
Webmaster, eRadius
Associate Editor, J Hand Surgery
Director, San Francisco Bay Area Hand Club

(case submitted April 22, 2008)

The patient is a 48 YO white male who was riding a motorcycle when a truck came around a corner in his lane and struck him head-on. He was helicoptered to a Level 1 Trauma Center. His injuries included loss of consciousness, an open-book pelvis fracture, and an open distal radius (5mm volar wound)/closed distal ulna fracture. The following xrays were taken:

These are the xrays (PA, lateral) obtained on presentation to the ER

The patient has an altered level of consciousness and is requiring BP support. A trauma surgeon will manage everything other than the wrist. You are the surgeon on call for hand.

(1) What are your treatment options? Which one do you choose?

(2) The trauma surgeon obtains a CT of the pelvis, diagnoses an open book fracture, and plans to go to the OR to plate the symphysis pubis as soon as the head CT is completed and the head cleared. When do you want to go to the OR?

(3) Besides treating the open wound and the radius & the ulna, is there any additional procedure you would perform?

(4) What about this fracture configuration is going to be a challenge?

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