George Balfour, MD
Academic Affiliation

(case submitted January 7, 2005)

The patient is a 45 year old male roofer who fell just before the 2005 IFSSH meeting, suffering an open fracture. He was brought into the Emergency Room, where only this film was obtained.

Figure 1a injury film

The general orthopaedic surgeon on call asked me to assist him. We washed out the open fracture. The degree of communution we found was impressive. The reduction very difficult and an attempt at an ORIF with a volar plate and fragment specific fixation was attempted. I felt I was nailing the classic pudding to the wall. The result not very satisfactory, but at the time was the best we could do. I left the OR very unhappy with what we were able to accomplish.

Figure 2a and 2b Initial reduction and ORIF

I travelled to Budapest for the IFFSH, where I button holed Jesse Jupiter. Fortified with some new ideas regarding the management of this fracture, I came back from Europe, took the patient back to the OR, opened the dorsum, wedged the distal radius forward. What does that tell you about the volar fixed angle plate fixation? I first added the ex fixator, then wedged out the radius and filled the metaphyseal defect with a CaPO4 filler. This stuff, called Os-Gen, turns hard. I have had ball of it soaking in water on my desk for 6 months and it is just now getting soft. The reduction obtained is shown in Figure 3.

Figure 3a and b Second reduction and ORIF/Ex Fix

The patient was several months later. He does not have much pain, the flexion/extension is about 50% and pro and sup about 50%. He has not returned to his job as a roofer yet and really does not expect to going back to construction.