Synopsis: 35 YO white male who fell off a roof two weeks ago.

These are the xrays upon presentation.

 

 

(1) What considerations make this fracture unusual?

The carpus is dislocated dorsally, implying that the volar ligaments are torn and will need to be repaired. The fact that the fracture is two weeks out means that the newly-formed callus will be fairly developed and will need to be removed if the fracture is to be reduced.

(2) What would be your first option?

There are many options. My choice was to approach the fracture dorsally at first, to remove the callus, reduce the fracture, and provisionally fix it. Next, I planned to do a volar approach, place a fixed-angle plate, and repair the volar capsule.

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