Distal Radius Fractures

Figure A depicts the radiograph of 79 year-old right-hand dominant woman who fell on her left wrist. According to meta-analyses & systemic reviews, which of the following statements is the most accurate regarding her injury?

• Improved functional outcome with ORIF through FCR approach vs. closed treatment

• No difference in radiographic outcome after ORIF vs. closed treatment

• No difference in functional outcome after ORIF vs. closed treatment

• Improved functional outcomes with closed treatment vs. ORIF

• Improved functional outcomes with external fixators + K-wires vs. ORIF

Which the following distal radius fractures is associated with volar translation of the carpus relative to the radial articulation?

• Displaced impaction fracture of the lunate fossa

• Displaced intra-articular fracture with a fragment consisting of the volar-ulnar corner

• Displaced radial styloid fracture

• Displaced extra-articular fracture with apex volar

• Displaced extra-articular fracture with apex dorsal

A 57-year-old woman underwent open reduction internal fixation from a volar approach for a displaced distal radius fracture. Immediate post-operative radiograph is seen in Figure A. The patient recovered well initially but presents after 6 months with grip weakness. What complication is most likely to occur in this patient?

• Inability to extend the index finger proximal interphalangeal joint.

• Inability to flex the index finger proximal interphalangeal joint.

• Inability to extend the thumb interphalangeal joint.

• Inability to flex the thumb interphalangeal joint.

• Inability to abduct the thumb.

A 56-year-old woman sustains the closed injury depicted in Figure A. On examination, her wrist is mildly swollen and she is unable to actively oppose her thumb. She also complains of some paresthesias in her thumb and index finger. The patient undergoes closed reduction and splinting; however, her paresthesias worsen significantly in the next 12 hours. What is the likely mechanism of her paresthesias and most appropriate treatment?

• Nerve compression; open reduction internal fixation with open carpal tunnel release

• Nerve laceration; open reduction internal fixation with primary nerve repair or grafting

• Decreased arterial inflow; fasciotomy with open reduction internal fixation

• Reflex sympathetic dystrophy; vitamin C

• Nerve compression; repeat closed reduction

17-year-old male falls from a retaining wall onto his left arm. He sustains the injury shown in Figure A. The patient undergoes open reduction and internal fixation of the fracture. Upon discharge from the hospital the medication reconciliation includes an order for daily Vitamin C 500mg supplementation. This medication is given in an effort to decrease the incidence of which of the following?

• Upper extremity deep vein thrombosis (DVT)

• Acute carpal tunnel syndrome (ACTS)

• Complex regional pain syndrome (CRPS)

• Lower extremity deep vein thrombosis (DVT)

• Surgical site infection (SSI)

A patient reports hyperesthesia over the base of the thenar eminence following volar locked plating of a distal radius fracture. A standard volar approach of Henry was used. What is the most likely cause of the hyperesthesia?

• Complex regional pain syndrome

• Wartenberg’s syndrome

• Carpal tunnel syndrome

• Palmar cutaneous nerve injury

• C7 radiculopathy

A 54-year-old male falls from a ladder and sustains the fracture shown in Figure A. Which of the following factors has been associated with redisplacement of the fracture after closed manipulation?

• Triangular fibrocartilage complex tear

• Open injury

• Ipsilateral radial head fracture

• Time to reduction

• Severity of initial displacement

A 46-year-old woman sustains an extra-articular fracture of the distal radius and undergoes open reduction and internal fixation with a volar plate and screw construct. During postoperative recovery from this injury, what benefit does formal physical therapy have as compared to a patient-guided home exercise program?

• Greater grip strength at 6 months

• Less wrist pain at 1 year

• Better hand dexterity at 1 year

• No difference in functional outcomes

• Quicker return to work

A 58-year-old man underwent distal radius ORIF with a volar locking plate yesterday. Preoperatively, he reported some mild sensory disturbances in the volar thumb and index finger, but had 2-point discrimination of 6mm in each finger. Now, he complains of worsening hand pain and sensory disturbances in his volar thumb and index finger. Two-point discrimination is now >10mm in these fingers. Radiographs show a well-fixed fracture in good alignment. What is the most appropriate treatment at this time?

• Strict elevation

• Removal of hardware

• Immediate carpal tunnel release

• Trial of night-splinting

• Carpal tunnel release if no resolution at 6-12 weeks

A 32-year-old ballet dancer sustains a distal radius fracture, and is subsequently closed reduced and casted. She presents 11 months later with the radiograph seen in Figure A, complaining of significant wrist pain. What is the appropriate surgical treatment at this time?

• Distal radius corrective osteotomy

• Total wrist arthrodesis

• Proximal row carpectomy

• Scaphoid excision and four corner fusion

• Interposition arthroplasty