Clinical case - Wrist multi-fragmentary ulnar fracture

Clinical case - Wrist multi-fragmentary ulnar fracture


Dear Friend,

Can you please access this case to advise on this complex wrist injury? Advice is mainly needed for the multi-fragmentary ulnar fracture.

Many thanks,

Phil Grieve - Ireland


Crazy Case. Reasons for falling need to be addressed as well I guess.

The Reconstruction of the Ulna or waiting won’t lead to a pleasurable Result.

Go for a prosthesis after Consolidation of the Radius.

If mandatory RSL Fusion and Ulna Head Prosthesis. I have seen good results according a case like this.

Only the brave!

Best,

Justin Hasenecker - Germany


Hi Phil,

terrible case, but as you have already proposed, I also would do ORIF of the radius by an extended volar and a dorsal approach but with (additional) application of a dorsal bridging / spanning plate (second or third metacarpal to the radius). And may be you can leave the ulna fracture alone (see the picture) or you also have to try to address the terrible ulna fracture with a locking plate and additional k-wires. Then I would wait and see until the removal  of the bridging plate after three month. Depending on the bony healing status you will then have other treatment options as mentioned by Justin, if necessary.

The bridging / spanning plate is in my hands a good reconstructive rescue / salvage option. Have a look at the chapter of Scott Wolfe 2014 AAOS Instructional Course Lectures, Volume 63.

Best regards

from Germany


Hi Phil,

I think, you cannot regain normal function in this terrible case, even if you do heroic attempt to reconstruction, with dorsal and palmar approach. At the end, when salvage is decided, the soft tissues are scarred, and the function would not be good anyway. 

The scaphoid and lunate facet and also the sigmoid notch are smashed, and also the ulnar head. I would discuss with the patient the primary RSL fusion and debridement of the distal ulna fragments. I would use a lazy S incision proximally swinging in ulnar direction. With a special RSL fusion plate we could fix the SL complex to the radial shaft, bridging over the multiple radius fragments, with a minimal shortening, so the distal ulna would remain as after a distal Darrach. I think he is too young for prosthesis, and later on are still possible with either distal ulna replacement or Aptis, through the same incision.

So, one operation, predictable outcome, and possibility for further procedures on the distal ulna in the future.

With best regards

Istvan Zoltan Rigo - Norway


Having fixed a very similar case last year which had ex fix and k wires done as initial  procedure for an open fracture in 68yr old keen biker, 

Managed to get a decent outcome with spanning plate for radius and locking plate for ulna, both plates were removed at 3months

Beat wishes

Rajesh Sethi - United States

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