Open Reduction Internal Fixation and Bone Grafting Distal Radius Nonunion

This patient is a 64 yo female who fell in Colorado while hiking in the mountains.  She sustained an open and contaminated distal radius fracture and was taken to a local emergency department.  That night, the open wound was cleansed and a spanning internal plate was applied with the wrist distracted as a means to reduce the multiple fracture fragments.  The wound healed but the fracture did not.  She presented to the office weeks later with pain, extreme stiffness of her wrist and fingers, and overall poor function.  She had no history of infection. 


PA and Lateral injury x-rays revealed the severe comminution and deformity involving the distal radius and ulna metaphysis and joint.

Open Reduction Internal Fixation and Bone Grafting Distal Radius Nonunion xray
post-op x-rays

The spanning plate across the wrist resulted in improved fracture alignment as a result of distraction, however, the 4 month post-op x-rays revealed the fracture was not healing, possibly a direct result of this distraction (green arrow).  This is documented on the CT scan (blue arrow).

intercalary bone graft

The nonunion was treated with removal of the spanning plate and placement of a 3 centimeter intercalary bone graft (green arrow) taken from the iliac crest (hip).  The graft healed, and the extra-articular parameters were restored, along with the joint surface.

wrist motion restored

Virtually full, painless motion was restored to the injured left wrist.

wrist motion restored