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CHAPTER 8 • Fractures of the Distal Radius and Ulna

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Figure 8-47.  A: Clinical photograph depicting the dorsoulnar curvilinear incision used to approach the dis- tal radioulnar joint in a patient with an irreducible Galeazzi fracture. B: Intraoperative photograph depicting the sigmoid notch of the distal radius. The ECU and EDQ tendons are seen retracted volarly and radially. The volarly displaced distal ulna remains dislocated. (Courtesy of Children’s Orthopaedic Surgery Foundation.)

Open reduction and internal fixation of the radius is done through an anterior approach. Standard compression plating is preferred to intramedullary or cross-pinning techniques (Fig. 8-48). Stable, anatomic reduction of the radius almost always leads to stable reduction of the DRUJ dislocation. A long-arm cast is used for 6 weeks to allow fracture and soft tissue healing. If the DRUJ dislocation cannot be reduced, it is exposed as described above. Typically after anatomic alignment of the

radius and extraction of any soft tissues blocking DRUJ reduc- tion, the joint is stable and no additional fixation is required. In cases of extreme instability and/or soft tissue compromise, smooth K-wire fixation of the DRUJ can be used to maintain reduction and allow application of a loose-fitting cast. The K-wire(s) are placed with the forearm in supination and passed transversely across from the reduced DRUJ from the ulna to the radius (usually all four cortices penetrated), and the pin(s) left

Figure 8-48.  A: The patient with a pronation injury had a closed reduc- tion and attempted fixation with pins placed percutaneously across the frac- ture site. However, this was inadequate in maintaining the alignment and length of the fracture of the distal radius. B: The length of the radius and the distal radioulnar relationship were best rees- tablished after internal fixation of the distal radius with a plate placed on the volar surface. The true amount of short- ening present on the original injury film is not really appreciated until the frac- ture of the distal radius is fully reduced. (Reprinted from Wilkins KE, ed. Oper- ative Management of Upper Extremity Fractures in Children . Rosemont, IL: American Academy of Orthopaedic Sur- geons; 1994:34, with permission.)

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