BMerk at nmff
New User
Dec 13, 2007, 5:35 AM
Post #5 of 7
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I saw this patient in my office yesterday. She has a chronic atrophic
nonunion of the ulnar diaphysis which was, believe it or not, basically
asymptomatic. The previous radius fracture had healed with the unusual
primary treatment with excellent function and no pain until this fall a
few days ago. The current fracture of the radius is distal to the
previous fracture by approximately 2cm and is largely a simple
transverse pattern without comminution. She intially had >45degrees of
angulation of her forearm through the new fracture of the radius with
commensurate bending of the iM pin as well as thru the ulnar nonunion. I
trust that the fatigue failure of the ulnar pin is, again, chronic. She
was reduced by an orthopaedist in India and splinted. He did a great
job. The radius alignment is now basically anatomic and splinted by the
IM pin which is bowed but not broken. She is now in a LAC with post
cast xrays showing maintenance of excellent radial alignment and an ulna
which is chronically nonunited. I told the patient that the the only
advantage of surgery, as I see it, is earl motion vs 6 weeks in LAC. The
radius should heal and is held by the pin and should be OK as long as
the alignment is maintained. Again, the ulna was per history recognized
to have not healed and was, per the patient, asymptomatic. I also
reviewed with her the option of pin extraction, ORIF of the radius +/-
ORIF of the ulnar nonunion with intercalary autograft. Not unreasonably,
she declined.
Bradley R. Merk MD
Assistant Professor of Orthopaedic Surgery
Director of Orthopaedic Trauma
Feinberg School of Medicine
Northwestern University
675 North Saint Claire, #17-100
Chicago, IL 60611
(312) 695-6800, clinical office
(312) 926-4444, academic office
(312) 695-2736, voice mail
312-695-2771, fax
________________________________
From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
Behalf Of dipti.gupta@aurora.org
Sent: Wednesday, December 12, 2007 8:16 PM
To: ORT-L@www2.aaos.org
Subject: [ORT-L] Ortho trauma case
This is a 53 yo female with history of left radius and ulna midshaft
fractures s/p internal fixation with intermedullary pin of both bones in
2002. The patient sustained a fall again 4 days ago with re-fracture at
the ulnar midshaft (suspected non-union) and as well as the fracture of
the intermedullary pin. The radius also re-fractured with bending of
that pin. The forearm was reduced with good alignment of the radius. The
question is what should be done with the ulna which is still displaced
with the fracture of the pin. One of the problems is that the ulnar pin
does not have a hook which can be used for retrieval. Given that the
retrieval of this would be challenging, what should be done? I am
attaching the pre- and post reduction x-rays for your perusal.
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