(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: A closed fracture is usually one in which the fracture site is not connected to the outside world and the skin mucosa remains intact. In this patient, a fall occurred with the hand braced against the ground and the violence transmitted upward, resulting in symptoms such as swelling and pain in the wrist joint, which was confirmed to be a closed fracture of the distal radius after radiography. In order to restore the function of the wrist joint, the patient was treated with incisional repositioning titanium plate screw internal fixation, after which the patient’s symptoms such as swelling and pain as well as the function of the wrist joint were gradually restored.
Basic information】Male, 60 years old
Disease Type】Distal radius closed fracture
Hospital】Harbin First Hospital
Date of Consultation】December 2021
Treatment plan】Surgical treatment (incisional repositioning titanium plate screw internal fixation)
Treatment period】7 days of hospitalization and 1 month of outpatient follow-up
Results】The fracture was repositioned and fixed, the discomfort was relieved, and the wrist joint resumed movement.
I. Initial consultation
The patient had osteoporosis and weakened distal radius bone. When she fell, she landed on the palm of the affected hand and was confirmed to have a closed fracture of the distal radius after X-ray examination, which caused swelling, pain and limited movement of the wrist joint and was accompanied by local fracture deformity. It was difficult to ensure the stability of the fracture end and would affect the function of the wrist joint by using external fixation with manual repositioning, so the patient was advised to consider surgery to restore the stability of the fracture end as well as the function of the wrist joint by incision and internal fixation, and gradually return to normal life through rehabilitation exercises after surgery. After consideration, the patient agreed to be admitted to the hospital for further surgical treatment and fully understood the risks of the surgery itself.
II. Treatment process
I informed the patient that conservative treatment would easily lead to stiffness and adhesions in the wrist joint, which would affect the range of motion and function of the wrist joint, so the patient chose surgery after careful consideration. During surgery, it was confirmed that the patient had a closed fracture of the distal radius with a relatively obvious displacement of the fracture end and a blood clot formation, which affected the contact of the fracture end and the stability of the fracture end was poor. After the fracture end of the distal radius was repositioned using a fracture repositioning forceps and fixed with a titanium plate screw, the surgical incision was closed and local pressure bandage was applied after confirming the stability of the fracture end. After surgery, the patient elevated the affected limb continuously to eliminate swelling, and began wrist joint movement and fist clenching exercises under the guidance of the rehabilitation physician to gradually restore wrist joint function and range of motion.
III. Treatment effect
The use of incisional repositioning titanium plate screws for internal fixation restored the stability of the closed fracture of the distal radius and ensured normal wrist joint space, which facilitated the rapid restoration of wrist joint range of motion and wrist joint function after surgery. The patient was discharged one week after the surgery with significant relief of pain symptoms and was able to perform active flexion and extension and rotation of the wrist joint under the guidance of the rehabilitation physician, and no clinical manifestations such as stiffness and decreased flexibility of the wrist joint were observed after one month and several times later.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but after discharge, we still remind the patient that he needs to strictly observe his body temperature and come to the hospital for regular follow-up blood tests to confirm that no infection has occurred. If the patient develops fever, pain, redness and swelling after discharge, further follow-up visits to the orthopedic clinic are needed to confirm the presence of local infection, which may lead to serious bone marrow inflammation with adverse consequences if it occurs. In addition, after discharge from the hospital, you also need to pay attention to the complete recovery of wrist joint function after fracture healing, pay attention to the surgical site not to be pressed and exerted, and insist on rehabilitation exercises to ensure both smooth healing of closed fracture and at the same time ensure that wrist joint function is not affected by the fracture. At home, you can increase the intake of calcium, protein, vitamins and other nutritional elements such as bone broth, egg custard, chicken breast, and fresh fruits and vegetables to promote bone recovery.
V. Personal insight
Closed fractures of the distal radius can easily involve the wrist joint, resulting in wrist joint dysfunction, such as wrist stiffness, which affects normal life, work, and sports. After the fracture of the wrist joint, the patient chose surgery in time and actively cooperated with rehabilitation training after surgery to ensure smooth healing of the fracture and normalization of the wrist joint function. In daily life, the patient needs to pay attention to the prevention of trauma to the wrist joint to avoid the recurrence of closed fracture of the distal radius.