Clinical Example: Intraarticular Distal Radius Malunion

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.

No prior films were available. Plain films suggested a depressed section of the radial edge of the lunate fossa and loss of dorsal tilt.

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: