Gustavo Mantovani , MD
Chief of Hand Surgery and Orthopaedic Surgery
Red Cross Hospital, Sao Paulo, Brazil

(case submitted August 22, 2007)

The patient is a 75 YO woman with Type II diabetes. (Incidentally, she is also a famous cardiologist colleague's mother, and a orthopaedic surgeon's grandmother, so of course, the case did not go as planned.) She originally fractured this radius more than 20 years earlier and developed a malunion. She again sustained a fracture of her distal radius and ulna 8 months previously, and presented to me. I treated her with a Synthes volar plate to radius and a Synthes 2.0 mm plate to the distal ulna, with suture of TFC complex to the plate (for a picture of the technique, see Case 13, page 3). At her last visit, 6 months after surgery, she had full mobility, no pain, and the patient was very satisfied about the treatment. However, the xrays suggested that she might have a nonunion. Now, 8 months after her surgery, she fell again, with pain and deformity.

These are the xrays upon presentation.


(1) Do you think the fracture had healed? Can you be sure?

(2) What would be your first option?


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