Synopsis: 35 YO white male fell off his horse playing polo.

These are the xrays (PA, lateral) obtained on presentation to the ER

 

(1) How would you describe the fracture to a fellow orthopedist?

I would describe this as a displaced highly comminuted distal radius fracture, with comminution of the articular surface and the metaphyseal bone, extending into the distal shaft a short distance.

(2) There are many options, but what should be done first?

The patient should first have a closed reduction, (1) to decrease pain, (2) reduce the stretch on the soft tissues, (3) reduce the stretch to the median nerve, and (4) to allow better xrays for planning purposes.

(3) What would your first option be? If that does not work, what would your fallback option be?

This patient obviously needs surgery, but I prefer to wait a few days before proceeding. I cannot plan my options until I see the post reduction xrays.

 

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