Patient age and gender:
16 year old Male
HPI
A 16yearold righthand dominant male was
involved in a dirt bike accident while riding at approximately 15–25 mph and
struck a tree. He experienced immediate, severe pain with obvious deformity
to his left wrist, associated with numbness in the median nerve distribution, as
well as pain in the right hip and lower back. He reported no loss of
consciousness or head trauma. There were no treatments prior to hospital
evaluation, and he was transported to the emergency department by private
vehicle. Upon arrival, his injuries were found to include a comminuted, intraarticular distal left radius fracture with displaced fragments, minimally
displaced fractures of the L4 and L5 spinous processes, and a rightsided
lower trunk subcutaneous hematoma, along with multiple abrasions. Initial
management in the emergency department consisted of closed reduction and
splinting of the left distal radius under procedural sedation, which resulted in
improvement of his median nerve symptoms.
Relevant past medical history:
None. Otherwise healthy.
Relevant physical findings:
On presentation, the patient had significant
deformity of the left wrist with an obvious gross deformity of the distal radius,
severe pain with markedly limited range of motion, focal tenderness, and
decreased median nerve distribution prereduction. After closed reduction
under sedation, sensation in the median nerve distribution improved and
capillary refill was less than 2 seconds. There was also minimal right lower
torso/hip swelling and soft tissue abrasion without significant open wounds.
Interpretation of laboratory and imaging studies:
Preoperative radiographs of
the left wrist demonstrated an acute, comminuted, displaced intraarticular
distal radius fracture with approximately 11 mm of dorsal translation of the
distal fracture fragment relative to the radial metaphysis, as well as a
minimally displaced ulnar styloid fracture. CT imaging of the cervical, thoracic, and lumbar spine revealed acute, minimally displaced L4 and L5 spinous
process fractures with no cervical or thoracic spine involvement. CT of the
chest, abdomen, and pelvis demonstrated a subcutaneous hematoma of the
right flank with no extravasation, intraarticular distal radial fracture with
posterior subluxation, fracture of the L5 spinous process, and a questionable
fracture of the midL4 spinous process. CT head was negative for acute
pathology. Pelvis xrays did not demonstrate diastasis or acute pelvic fracture.
Diagnosis
Comminuted intraarticular distal left
radius fracture with dorsal translation; minimally displaced ulnar styloid
fracture; acute, minimally displaced spinous process fractures of L4 and L5;
right hip and right flank subcutaneous hematoma; traumatic abrasions right
lower torso, right elbow, right knee, and left forearm.
Treatment plan (Op and Non-Op)
Nonop: Shortterm
nonoperative management was discussed, including splinting the left wrist,
NSAIDs, rest, and activity modification. However, due to severe distal radius
deformity with intraarticular comminution, continued immobilization alone
risked permanent dysfunction and did not provide satisfactory restoration of
alignment or articular congruity. Operative: Open reduction and internal
fixation of the distal radius was discussed as the preferred method to improve
alignment, reduce the risk of posttraumatic arthritis and allow for controlled,
early motion, given the magnitude of displacement and instability.
Primary surgical indications
The patient sustained a displaced, comminuted
intraarticular fracture of the distal radius with significant dorsal translation
and loss of alignment. Preoperative examination confirmed severe pain and
deformity, with imaging demonstrating severe malalignment unlikely to
improve with nonoperative measures. The intraarticular involvement and
displacement in a young, otherwise healthy patient was a indication for
surgical stabilization to help restore anatomic alignment and with the goal of
preserving longterm function.
Procedure(s) and date(s) of surgery:
03/18/2024 Open reduction and internal
fixation of left distal radius fracture
Length of surgery:
2 hours 26 minutes.
EBL:
30 cc
Postoperative course:
POD 0: volar splint applied. PO 3 wk: volar splint d/c’d,
wrist carpal tunnel brace fitted (to wear except bathing and for gentle ROM);
weightbearing 〈1 lb L hand; gentle ROM exercises for wrist and fingers started. PO 7 wk: continues wrist brace part time, WBAT initiated, avoid
impact/falls x 6 wk, formal PT offered but opting for home exercises. ROM:
flex/ex 60/60, pro/sup 90/90. PO 58 wk: Telephone followup, spoke with
motherpt remained active, returned to work and weightlifting, occasional wrist
soreness; no change to splinting or therapy.
Date of most recent followup:
4/24/2025
Total length of followup:
56 weeks
Are you happy with the outcome?
Yes, I thought good reduction and fixation of
the distal radius was obtained. The patient regained functional use of the
wrist, was able to return to work and recreational activities, and did not require
additional intervention.
Were there complications?
No
What went well in this case?
The patient achieved good reduction and stable
fixation of a complex distal radius fracture, allowing return to normal daily
activities, work, and weight lifting, with satisfactory range of motion and
minimal persistent symptoms.
What might you do differently in future?
I would consider encouraging earlier
participation in supervised therapy to optimize range of motion and better
counsel the patient and family on the importance of scheduled follow up.
