(1) What is your diagnosis?

The patient has a distal radius fracture that appears to be extraarticular. He almost certainly has an injury to the TFC, due to the displacement of the distal radial articular surface. The median nerve is not out clinically, but with the degree of dorsal displacement of the distal fragment, the median nerve is definitely at risk.

(2) Do you need any additional studies?

Traction views at the time of reduction would help to define the anatomy, are inexpensive, and easy to obtain.

(3) What are the treatment options? Which one would you suggest?

A closed reduction should be done at this time, if for no other reason than for patient comfort and the fact that the median nerve needs to be relieved of stress as soon as possible. The definitive procedure will almost certainly involve an ORIF (volar plate, dorsal plate, fragment specific), percutaneous pinning, or ex fix, due to the degree of instability based on the degree of displacement. My choice would be a locked volar plate.

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