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Synopsis: 75 YO woman, malunion from a radius fx 20 years ago, second fx 8 months ago (Synthes volar plate to the radius and a Synthes 2.0 mm plate to the distal ulna, with suture of TFC complex). At 6 months, full mobility, no pain, but doubts about nonunion on xray. Now, 8 months after her surgery, a third radius fx from a fall.
(1) Do you think the fracture had healed? The edge of this fracture (seen on both the PA and the lat) seems to show a chronic nonunion, as well as lucencies around the screws seen on the lateral. Also, the titanium plate would be more likely to bend or pull out of the bone if there had been union; the fracture of the plate suggests chronic plate loading. The appearance of the ulna on the "PA" view also suggests a nonunion there. (2) What would be your first option? The only option seems to be plate removal and re-plating. (3) Anything special that should accompany the revision? |
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