The patient is a 73 YO woman who was walking with her walker in the back yard and lost her balance, striking her left non-dominant wrist against a brick wall. She was brought by amulance to the ED. Her radius and ulna were protruding through two dorsal wounds:

Dorsal view of the wrist, with the radial side up, fingers to the left. Note the two wounds.

Side view of the radius

Side view of the ulna

These xrays were obtained:

Injury xrays (PA, oblique, lateral)

 

(1) What would your recommendation be with respect to the debridement?

(2) What would be your treatment in terms of timing: delayed fixation after a second look and debridement, or immediate fixation?

(3) What would your choice of fixation be, ex fix or internal fixation? What kind of internal fixation?