PMC9946760_01
Injury films and preoperative CT scan. A-B) anteroposterior and lateral X-rays views of the right wrist: comminuted volar Barton distal radius fracture with loss of radial height and volar radial tilt. C-E) coronal, sagittal, and axial views of CT scan showing comminuted fracture pattern, depressed articular surface.
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FIG1
Radiographs demonstrated a right, comminuted distal radius volar Barton fracture (Figure 1). Given significant comminution, a pre-operative computed tomography (CT) scan was obtained for surgical planning (Figure 1).
Intraoperative and postoperative films. . A-B) intraoperative fluoroscopy. C-D) two-week postoperative anteroposterior and lateral X-rays views of the right wrist: volar plate and hook plate appearing intact, with the restoration of the articular surface, radial height, and radial tilt.
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FIG2
It was performed with a standard volar approach to the wrist and fixation was achieved with a 3.5 mm volar locking plate, and a hook plate (Skeletal Dynamics, Miami, FL) (Figure 2).
Follow-up X-rays and MRI. A-C) Four-month postoperative anteroposterior, oblique, and lateral X-ray views of the right wrist: metaphyseal lucency, intact hardware, and some loss of radial height. D-F) coronal, sagittal, and axial T2 MRI sequence showing dorsal metaphyseal hyperintense lesion.
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FIG3
A radial metaphyseal lucency was found on radiographs (Figure 3). Proximal to Lister's tubercle, a periosteal reaction and a peripheral enhancing cyst were found on the T2 sequence (Figure 3), the latter measuring approximately 7 x 8 x 8 mm.
Follow-up X-rays and MRI. A-C) Five-month postoperative anteroposterior, oblique, and lateral X-rays views of the right wrist: enlarged metaphyseal lucency with a dorsal cortical appearing breach, intact hardware, and continued loss of radial height. D-F) T1 coronal, T1 sagittal, and FS T2 sagittal MRI sequences showing enlarged, dorsal metaphyseal lesion T1 hypointense and T2 hyperintense classic for giant cell.
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FIG4
A new MRI was obtained for re-evaluation prior to definitive surgery and showed a T1 hypointense and T2 hyperintense expansile lesion with cortical destruction, measuring 3 x 2.4 x 4.2 cm (Figure 4).
Postoperative X-rays and follow-ups.. A-B) immediate postoperative anteroposterior and lateral X-rays; C-D) four-week postoperative anteroposterior and lateral X-ray views of the right wrist: hardware and cement appearing intact. There is residual loss of radial height radial, tilt is neutral, with unchanged bone resorption and lucency at the cement bone interface. Cement extends dorsally and volarly due to cortical breach. E-F) Volar and dorsal right wrist incisions with sutures in place at three weeks postoperatively.
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FIG5
The dorsal incision was well-healed, and the volar incision had no signs of dehiscence or infection but showed delayed healing (all sutures were kept for three to four weeks), and minimal swelling (Figure 5).