Clinical Example: Intraarticular Distal Radius Malunion

Because of the biplanar angulation and curvature of the distal radius, the alignment of intraarticular distal radius fractures may be difficult to estimate by plain radiographs.
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This patient presented with persistent wrist pain, swelling and stiffness one year out from closed reduction and external fixation of a n intraarticular distal radius fracture.
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No prior films were available. Plain films suggested a depressed section of the radial edge of the lunate fossa and loss of dorsal tilt.
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On first glance, 3D CT reconstruction looked favorable for possible simple dorsal opening wedge corrective osteotomy.

Below, a fly-around video of the 3D reconstruction:

Digitally hiding the carpal bones obstructing the view of the distal radius shows a much more significant articular defect. In these views, the proximal cortex of the scaphoid remains as a yellowish shell - it could not be cleanly removed because it is in bony contact with the dordal lip of the radius.

Video fly around view of the distal radius articular surface:
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