T Guest Professor David Nelson Case 2 I
David Nelson , MD
Private Practice, San Francisco
Webmaster, eRadius
Associate Editor, J Hand Surgery
Director, San Francisco Bay Area Hand Club

Plain xrays after the second surgery.

CT view after the second surgery.

The plan was to remove the distal radial screws that were going into the joint and the ulnar facet fragment of the radius (via a volar approach) and free up this fragment (which would require a dorsal approach). Next, remove the two most distal screws from the plate on the ulna, and free up the ulnar fragment. This would allow the DRUJ complex to be mobilized and reduced. Removing either group of screws by themselves would not allow the DRUJ complex to be reduced. It was felt that neither plate would need to be moved and the majority of the screws could be left in place. This would also save operative time, which was expected to be lengthy. Given the anticipated length of the procedure and complexity, the assistance of an experienced orthopedic surgeon was requested.

Once both the radius and the ulna were reduced, the reduction would be checked by fluoroscopy. The complex would then be fixed by replacing the removed screws. The time at this point was six weeks after the original motorcycle crash, and the nascent malunions were expected to be a challenge to reduce.

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