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Abstract: The distal radius, also known as the forearm near the wrist, is prone to fracture under indirect violence when a person falls with the palm of the hand braced against the ground. This fracture is mostly seen in elderly female patients and is a common location for osteoporotic fragility fractures. The patient in this case is a 73-year-old man who fell and caused a fracture of the distal radius. After surgery, the morphology of the distal radius was restored and wrist motion was well recovered. Aggressive anti-osteoporosis treatment is needed in the later stage, and re-injury should also be avoided.
Basic information】Female, 73 years old
Disease Type】Distal radius fracture
Hospital】The First Hospital of Harbin Medical University
Date of consultation】December 2021
Treatment plan】Medication (mannitol injection, zoledronic acid injection, horse chestnut seed extract tablets, calcium carbonate D3 chewable tablets, vitamin D drops) + surgery (fracture incision and internal fixation)
[Treatment period] 14 days of hospitalization and regular review
Treatment effect】Fracture healing, normal wrist movement resumed
I. Initial consultation
The patient was 73 years old. After a fall, she suffered a fracture due to the palm of her hand supporting the ground during the injury, and subsequently developed swelling and pain in the wrist joint, accompanied by difficulty in wrist movement. Further examination at the emergency room revealed a typical “bayonet-like” deformity of the patient’s wrist, with significant swelling of the hand and wrist and tilting to the dorsal side of the hand. X-ray examination revealed that the fracture was significantly displaced to the dorsal side of the hand and the distal radius was shortened to an angular deformity. Based on the X-ray findings, the patient was diagnosed with a distal radius fracture.
II. Treatment history
After admission, the patient was firstly repositioned by manual traction, and the fracture form was generally restored to normal by stretching and traction, followed by temporary splinting. During the preoperative preparation, the patient was instructed to elevate the affected limb, and was given intravenous mannitol injection and oral horse chestnut seed extract tablets to reduce swelling. CT 3D reconstruction of the wrist joint was completed to clarify the fracture pattern, and preoperative tests such as vascular ultrasound of the upper limb, routine blood count, liver and kidney function, and coagulation images were completed. The patient was treated with fracture incision and internal fixation surgery on the 3rd day after admission, which took about 2 hours, and was protected by a brace for 3 days after surgery, and was given zoledronic acid injection intravenously, oral calcium carbonate D3 chewable tablets and vitamin D drops on the 5th day after surgery, and was discharged from the hospital after 14 days of comprehensive hospitalization.
III. Treatment effect
The patient showed mild swelling at the edge of the incision on the first day after surgery; the swelling was relieved on the third day after surgery, and there was no infection as well as skin necrosis; the stitches were removed on the 14th day after surgery, and the wrist joint resumed normal movement after surgery, and the mobility of other joints of the forearm was normal. There was pain at the incision after surgery, but no significant discomfort in the fracture area, and the pain was relieved 5 days after surgery. When the patient was discharged from the hospital, the patient could move his forearm normally without the protection of a brace. On review 6 months after surgery, the patient’s fracture healed and the forearm returned to normal function.
IV. Notes
We are glad that the patient’s fracture is gradually recovering. Since the distal radius is not a weight-bearing area, this patient does not need to be bedridden after surgery. To avoid joint stiffness, it is recommended that the patient be discharged from the hospital with normal wrist movement, not only for wrist flexion and extension, but also for rotation, but not for weight holding, such as lifting heavy objects. During the fracture healing stage, attention should be paid to calcium supplementation to prevent osteoporosis, and after the fracture is completely healed, the wrist joint can move and hold weight normally.
V. Personal insight
Distal radius fractures are common in elderly female patients, and when the fracture occurs, many patients often choose conservative treatment. It takes about 3 months for the fracture to heal using a cast, which is likely to lead to wrist stiffness and chronic pain later. This patient had a high level of activity on a regular basis and a high demand for wrist function, so surgery was ultimately the treatment of choice. The surgery allows for direct visualization of the fracture and joint surface and allows for the resumption of normal activities right after surgery, preserving the maximum amount of wrist function.