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Abstract: A 30-year-old young male sustained an injury to his right wrist due to machine crush, followed by severe pain in the right wrist, marked swelling, deformity, and limitation of wrist motion. This operation accidentally caused a fracture of the right distal radius, a powerful violent fracture that often causes loss of wrist function, and after giving him surgical treatment with incisional repositioning and double plate internal fixation, the fracture healed and a satisfactory treatment result was obtained.
[Basic information] Male, 30 years old
Disease Type】Distal fracture of right radius
Hospital】Liaocheng Second People’s Hospital
Consultation time】November 2021
Treatment plan】Intravenous injection (sodium hepaticoside for injection to reduce swelling + flurbiprofen injection) + surgical treatment (distal radius fracture incision and repositioning with double plate internal fixation)
Treatment period】10 days of inpatient treatment, 1 and 3 months of outpatient review
Treatment effect】The fracture healed and the right wrist joint function recovered well.
I. Initial consultation
The patient, 30 years old, was pushed into the clinic at 11:00 p.m. by a worker with a transfer cart, with a painful face and continuous moaning. On visual examination, we found that the patient’s right wrist was obviously swollen and deformed, with obvious local tenderness and pain, and accompanied by obvious bone rubbing sensation and abnormal movement.
II. Treatment history
After the family arrived, the patient and family members were explained the X-ray findings and informed of the treatment options available to them, either conservative treatment or surgical treatment. Conservative treatment required traction and external fixation of the fracture with a small wrist splint. Given that the fracture was a comminuted fracture with severe dislocation, manual repositioning was difficult, and external fixation was not secure, and there was a high possibility of fracture dislocation and malunion, which often caused traumatic arthritis and seriously affected the function of the wrist joint. Surgical treatment requires internal fixation of the fracture with an incision and repositioning plate under anesthesia, which is a reliable method of repositioning and fixation and allows the patient to perform functional exercises of the wrist joint at an early stage.
The patient had a high demand for wrist function and decided to undergo surgery after discussion with her family. After admission, the patient was given elevation of the right upper limb, local ice, and treatment with injectable heptaosaponin sodium to reduce swelling and flurbiprofen ester injection. After admission, routine blood tests, six coagulation tests and four preoperative tests were completed, and preoperative preparation was actively carried out. On the third day after admission, the distal radius fracture was treated with internal fixation by incision and double plates under brachial plexus anesthesia.
III. Treatment results
After 10 days of hospitalization, the patient’s incision healed well and the stitches were removed successfully. After surgical treatment, the patient’s right distal radius fracture was restored to normal anatomical correspondence, the wrist joint correspondence was restored to normal, and the internal fixation was firm and reliable, and the patient was discharged from the hospital.
One month after discharge, when the patient came to the hospital for review, the swelling of the right wrist joint had obviously subsided, and the flexion and extension activities of the right fingers had returned to normal, and the patient was instructed to gradually practice the rotation activities of the right wrist joint; three months after discharge, when the patient came to the hospital for review, the fracture had basically healed, and the flexion and extension and rotation activities of the right wrist joint had basically returned to the pre-injury level, at which time the patient was instructed to gradually start weight-bearing activities of the right wrist joint.
Notes
When the fracture starts to heal and the fracture line starts to blur, you can start to practice the right wrist joint rotation activities, but the force should not be too great and should be gradual; until the fracture is completely healed, avoid lifting heavy objects or doing strenuous exercises on the affected limb, and forbid Until the fracture is completely healed, avoid lifting heavy objects or doing strenuous exercises, and forbid throwing the affected limb with force to avoid secondary injury and affecting the recovery of the disease.
V. Personal insight
The patient’s distal radius fracture caused by high-energy injury has poor fracture stability and requires timely surgical incision and repositioning to restore the anatomical form of the distal radius and maximize the preservation of wrist joint function. For a comminuted fracture with a single plate fixation that is slightly less firm, an additional plate is needed to increase stability. In addition, postoperative functional exercise is best performed under the guidance of a physician, starting with the peri-fracture joint at an early stage, and gradually practicing wrist joint activities, first practicing wrist flexion and extension, and then rotational functional training to prevent loss of repositioning and failure of internal fixation, in order to maximize the return of the affected limb to its previous functional state.