case_images: PMC10874134_01
case_images: Antero-posterior and lateral radiographs on presentation. A: Note the significant comminution and disruption of the radiocarpal joint surface. B: Note the dorsal subluxation of the radiocarpal joint and the significant comminution of the dorsal radial metaphysics. C: Anteroposterior radiograph after reduction. Note the significant comminution of the radial column and the large fragments of radial metaphysis present in the radiocarpal joint, as indicated by a black arrow. D: Lateral radiograph after reduction. The radiocarpal joint is still subluxed due to a lack of subchondral support, both palmarly and dorsally.
case_images: cureus-0016-00000052487-i01.jpg
case_images: PMC10874134_01_cureus-0016-00000052487-i01.jpg
case_images: FIG1
case_images: His distal radius fracture was manipulated in the ED, and the position improved as much as feasible before going into a plaster of Paris backslab (Figure 1A-1D).
case_images: Three-dimensional reconstruction of the fracture. A: Note the significant comminution of the volar metaphysis and articular surface of the distal radius. B: Note the comminution of the dorso-radial metaphysis of the distal radius. The fragments that originated from the fracture bed were incarcerated in the radiocarpal joint.
case_images: cureus-0016-00000052487-i02.jpg
case_images: PMC10874134_01_cureus-0016-00000052487-i02.jpg
case_images: FIG2
case_images: A CT scan was arranged, which demonstrated the complexity of this injury in greater detail (Figure 2A-2B, Figure 3).
case_images: Axial computed tomography (CT) scan image. This demonstrates the significant comminution of the distal radius and displacement of the lunate and scaphoid fossae.
case_images: cureus-0016-00000052487-i03.jpg
case_images: PMC10874134_01_cureus-0016-00000052487-i03.jpg
case_images: FIG3
case_images: A CT scan was arranged, which demonstrated the complexity of this injury in greater detail (Figure 2A-2B, Figure 3).
case_images: Computed tomography (CT) coronal and sagittal reconstructions. A: This image demonstrates the displacement of cortical fragments within the radiocarpal joint, as indicated by the black arrow. These fragments were devoid of any soft tissue attachments. They were retrieved and reduced to the remaining dorsal distal radius. They were then stabilised with several suture knots. B: The black arrow demonstrates the displacement of the cortical fragments within the radiocarpal joint. The black arrow demonstrates the intra-articular position of the metaphyseal fragments.
case_images: cureus-0016-00000052487-i04.jpg
case_images: PMC10874134_01_cureus-0016-00000052487-i04.jpg
case_images: FIG4
case_images: Schematic demonstrating the dorsal aspect of the distal radius. The two main dorsal cortical fragments were retrieved from the radiocarpal joint, and multiple small perforations were made with a wire. These were placed in appropriate positions so that the fragments would then be approximated and held in place with multiple suture knots. Prior to this step, the metaphyseal defect in the distal radius was grafted with cancellous bone chips, creating a bed for the suture fixation construct.
case_images: cureus-0016-00000052487-i05.jpg
case_images: PMC10874134_01_cureus-0016-00000052487-i05.jpg
case_images: FIG5
case_images: The suture technique was not used to gain absolute stability but rather to reduce and stabilise loose cortical fragments in the correct orientation so that they would consolidate there (Figure 5).
case_images: Intra-operative images of distal radius. A: Demonstrating the placement of drill holes, which were used to reconstruct the radial metaphysis with sutures. B: This anteroposterior view shows the final outcome of stabilisation in theatre, with the external fixator attached. The transverse 2 mm wire was inserted to stabilise the distal radio-ulnar joint with the forearm in supination. C: Note the restoration of the joint surface and the correction of the dorsal tilt deformity..
case_images: cureus-0016-00000052487-i06.jpg
case_images: PMC10874134_01_cureus-0016-00000052487-i06.jpg
case_images: FIG6
case_images: The patient was placed in an above-elbow cast in a position of forearm supination (Figure 6A-6C).
case_images: Radiographs at final follow-up. A: Showing the restoration of the radial inclination and radial height and the consolidation of the fracture. B: Showing consolidation of the fracture and a small degree of residual dorsal tilt of the distal radius. This was due to the need for early removal of the external fixator as the pin sites became contaminated.
case_images: cureus-0016-00000052487-i07.jpg
case_images: PMC10874134_01_cureus-0016-00000052487-i07.jpg
case_images: FIG7
case_images: There was a degree of dorsal tilt of the articular fragment, most likely due to the early removal of the external fixator, which became necessary after the pin sites became contaminated (Figure 7A-7B).
case_images: Clinical images at final follow-up. A: Extension of the left (injured) wrist, compared to the right (uninjured) side. B: Flexion of the left wrist, compared to the right side. C: Pronation of the left wrist, compared to the right side. D: Supination of the left wrist, compared to the right side.
case_images: cureus-0016-00000052487-i08.jpg
case_images: PMC10874134_01_cureus-0016-00000052487-i08.jpg
case_images: FIG8
case_images: He was able to form a full fist and remains satisfied with his functional outcome (Figure 8A-8D).