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Table of Contents
Introduction
Distal Radius
Important notes: Transects brachioradialis unless elderly patient, does NOT repair pronator quadratus Sutures: 4-0 nylon for closure Dressing: xeroform Splint: If suspect DRUJ instability place sugar tong, otherwise volar splint.
ASSISTANT: ORIF left distal radius fracture; intraarticular in three parts Left distal ulnar styloid fracture . PREOPERATIVE DIAGNOSIS: Left Closed intra-articular distal radius fracture; in three parts Left distal ulnar styloid fracture POSTOPERATIVE DIAGNOSIS: Left Closed intra-articular distal radius fracture; in three parts Left distal ulnar styloid fracture OPERATION PERFORMED: Left Open reduction and internal fixation distal radius fracture, intra-articular, and three fragments. IMPLANTS: Acumed system DESCRIPTION OF OPERATION: x was identified in the Holding Area and the operative site was marked. He was brought to the operating theater in stable condition and placed onto a regular OR table with his operative arm on an arm board. A preoperative time-out was taken to ensure the patient's identity, operative procedure, as well as the operative location. General anesthesia was administered. His splint was removed and a tourniquet was placed onto his arm which was then sterilely prepped and draped. An Esmarch bandage was used to exsanguinate the limb before elevation of the tourniquet to 250 mmHg. We began the procedure by making a 10 cm incision longitudinally over his FCR tendon extending from his wrist crease and proximally. We dissected through subcutaneous tissue and identified the FCR tendon. We incised the tendon sheath, retracted the tendon ulnarly, and incised the subsheath. The distal aspect of the FPL origin was was retracted ulnarly to expose the pronator quadratus which was incised along its radial and distal borders and elevated subperiosteally. We released brachioradialis and identified the first dorsal compartment underneath. We identified the fracture site and cleaned the fracture of callus. We then used fluoroscopic imaging in order to confirm the ability to reduce the fracture. We then selected an long Acumed Acu-Loc 2 volar radius plate. The plate position was provisionally stabilized using 0.054 K-wires and then secured to the proximal fragment using a 3.5 mm compression screw. We then reduced the fracture onto the plate and stabilized the distal fragment using additional 0.054 K-wires. The position of the plate and the fracture reduction were confirmed using fluoroscopic imaging. We then secured the epiphysis and articular fragments to the plate using 2.8 mm locking screws. We completed stabilization of the plate to the proximal fragment using 3.5 mm locking screws. The final position of the plate and fracture reduction were confirmed using fluoroscopic imaging and we were happy with both. Clinical examination showed no impingement of his wrist range of motion and stability of the DRUJ in supination. The incision was washed. The pronator quadratus was not closed and the skin was closed using 4-0 nylon sutures in a horizontal mattress with steri-strips. A sterile dressing and sugar tong splint With the wrist in supination were applied. General anesthesia was reversed. He tolerated the procedure well. There were no complications. Final instrument count was correct. x was taken out of the operating theater and to the PACU in stable condition. POSTOPERATIVE PLAN: x will go home from the hospital today with arrangements made to follow up with me in clinic in two weeks. He will be transitioned into a short arm removable splint, which will be worn continuously for an additional four weeks with protected range of motion of his wrist initiated by Hand Therapy. He has been told to strictly elevate his hand at all times as well as move his fingers to prevent stiffness. If he has any difficulty or concerns between now and followup, he has been told to contact me, and I would be happy to see him sooner.