BACKGROUND: Due to its ability to provide stable fixation and permit early mobilization, volar plating has become the recommended technique for the surgical stabilization of distal radius fractures. The extensor pollicis longus (EPL) tendon may be injured or ruptured as a result of undetected screw penetration or drill plunging. During surgery, it is critical to detect any potential screw penetration so that it can be corrected.
METHODS: A 32-year-old woman presented six weeks post-distal radius plating with an inability to extend her left thumb. Clinical examination revealed loss of extension at the interphalangeal joint, stiff wrist, tender point over the dorsal aspect of the wrist, and an intact sensory nerve function.
CONCLUSIONS: Dynamic ultrasound and magnetic resonance imaging (MRI) both revealed no evidence of tendon rupture or EPL tendon movement. X-rays revealed the distal epiphyseal screws penetrating the far cortex. Intraoperatively, the EPL tendon was found to be impinged by a screw. The tendon was released, tenolysis was performed, and the distal screws were shortened.
CONCLUSIONS: In order to assess screw penetration into the far cortex, volar plating for distal radius fractures should be performed using intraoperative imaging views such as lateral, 45-degree supination, 45-degree pronation, dorsal tangential, and skyline views. Timely interventions after distal radius fracture fixation preserve tendon function, and early detection of tendon compromise is essential to preventing additional damage.

UNASSIGNED: Distal radius fractures account for nearly one-third of all pediatric fractures, making it among the most common of all pediatric fractures. Studies report that distal radius physeal arrest rates following trauma to the distal radius seem to occur in only about 5% of patients. Significant ulnar variance can develop leading to notable pain and limitations in function.
UNASSIGNED: We present a case of a 17-year-old right-hand dominant adolescent Caucasian male with persistent ulnar wrist pain. The patient presented to our outpatient clinic for evaluation of his left wrist following 6-8 months of persistent ulnar-sided pain. Ten months prior, the patient had fallen off a shed and was treated in the emergency room and referred to the outpatient clinic for follow-up. The patient initially sustained a Salter-Harris Type 2 distal radius fracture treated with closed reduction and short arm cast application in the emergency room. The short arm cast was removed at 8 weeks, and then, the patient was placed in a brace. The patient was lost to follow-up before returning to the clinic 16 months after the original injury when he noticed worsening pain in the left wrist, localized to the distal radioulnar joint with increased hand usage at a new job. Radiographs at that time showed a worsening positive ulnar variance as well as a partially open distal ulnar physis. After 6 months of occupational therapy and over-the-counter pain management, the ulnar-sided pain had not resolved. The radiograph showed a positive Ulna variance of 2.5 mm, which was corrected with a 5 mm excision osteotomy of the distal ulna. The patient reported significant pain relief and a 42-point improvement in his patient-rated wrist evaluation score.
UNASSIGNED: Distal radius growth arrest, while uncommon, can present with ulnar-sided pain and positive ulnar variance that is safely treatable with ulnar shortening osteotomy.

Wrist ganglion cysts are the most common benign soft tissue swelling in the hand and wrist. They may arise from flexor and extensor tendon sheaths, interphalangeal joints, wrist joints, and even the neural tissues around the hand and wrist. Some volar wrist ganglion cysts arise from the radiocarpal joint and scaphotrapezial joint. It is uncommonly encountered as an incidental finding during the fixation of a distal radius fracture. In our case, a volar wrist hemorrhagic ganglion cyst was incidentally found during the fixation of the fracture. Prior to the injury, the patient had no complaints of swelling over her right wrist. The cyst was removed using microscopic magnification.

UNASSIGNED: Wrist fractures, particularly the distal radius, can result in significant stiffness and hand dysfunction if not mobilized early. The variable immobilization period post-fracture depends on fracture type, location, stability, and surgical intervention. Inadequate early mobilization typically leads to structured stiffness, influenced by patient health, injury mechanism, joint surface involvement, associated tissue injuries, and patient motivation.
UNASSIGNED: A 64-year-old female in good health suffered a distal radius fracture, treated with open reduction and internal fixation. A modified treatment plan, including custom orthosis and active wrist exercises, was initiated after the standard immobilization phase to enhance the range of motion while accommodating the patient\'s daily activities.
UNASSIGNED: The patient underwent 15 evaluations of active range of motion (AROM) using a goniometer, guided by the American Society of Hand Therapists. A Tissue Composition Analysis (TCA) was performed to guide the orthosis-treatment choice. Despite consistent improvement shown in AROM, it was inconclusive whether the modified treatment contributed significantly beyond the standard approach.
UNASSIGNED: While the patient\'s AROM improved, the treatment\'s effect on this single case cannot definitively confirm the efficacy of the modified approach. A more extensive study is necessary to evaluate the conservative treatment strategy\'s validity for such fractures in high-demand patients, considering the biomechanical complexity of the injury and the patient\'s professional needs.

Necrotizing soft tissue infections (NSTIs), characterized by extensive soft tissue destruction, are rare but life-threatening. We present a case of a NSTI in a healthy 65-year-old woman following a closed distal radius fracture. The patient presented with severe pain, fever, and lethargy 4 days after her index injury, with physical examination of the right upper limb revealing erythema and swelling to the mid-humeral level and blisters of the fingers and hand. Multiple surgical debridements were required to control the infection, which was caused by Streptococcus pyogenes. This case highlights the rapid progression and devastating consequences of NSTI, which can occur even in the setting of closed injuries in patients without comorbidities. Prompt diagnosis, early surgical intervention, and appropriate antimicrobial therapy are crucial in managing this pathology.Level of Evidence: Level 5.

This case report presents an uncommon long-term complication of external fixator application to distal radius fracture. Despite an initial uneventful fracture healing, the patient presented with Brodie\'s abscess with Staphylococcus aureus osteomyelitis at the previous pin site 17 years later. A diagnosis of late-onset osteomyelitis, as a manifestation of quiescence chronic osteomyelitis, was made.

Background: Ulnar neuropathy after a distal radius fracture is rare and has limited reports in literature. As such, there is no consensus regarding the optimal treatment and management of such injuries. We report our experience with managing these uncommon injuries. Methods: A retrospective review was conducted where patients presenting with ulnar neuropathy after sustaining a distal radius fracture were identified from January 2021 to December 2023 from our hospital database. Results: A total of four patients were identified. All of them underwent surgical fixation for their respective fractures. None of them underwent immediate or delayed exploration and decompression of the ulnar nerve. All patients had clinical improvement at 3 months after their initial injuries. Three patients eventually had resolution of the neuropathy between 5 and 9 months post injury, while one had partial recovery and developed a neuroma but declined surgery due to symptoms minimally affecting work and daily activities. Conclusions: Ulnar neuropathy after distal radius fractures may not be as rare as previously thought. Expectant management of the neuropathy would be a reasonable treatment as long as there is no evidence of nerve discontinuity or translocation and that there is clinical and/or electrodiagnostic improvement at 3-4 months after the initial injury. Level of Evidence: Level IV (Therapeutic).

Dorsal spanning plates are frequently utilized to manage comminuted intra-articular distal radius fractures, but there is little literature on combining them with augmented fixation in complex cases. We present a 43-year-old man who fell 5 ft onto his outstretched right hand. On examination, there was gross swelling and tenderness of the right wrist with no neurovascular deficit. Radiographs confirmed a comminuted intra-articular displaced distal radius fracture. He was treated with a dorsal spanning plate fixation combined with radiostyloid and volar buttress plates. Follow-up at 2 months showcased intact hardware with good fracture healing. The dorsal spanning plate was removed 4 months after the procedure with radiographs demonstrating adequate alignment and healing without failure. The patient reported no complaints and minimal functional disability. We highlight a case of augmenting a dorsal spanning plate with fragment-specific plate fixation for a comminuted intra-articular displaced distal radius fracture.

Distal radius fractures (DRFs) are prevalent among all hand injuries, commonly due to a fall on an outstretched hand. Not being treated properly can cause many complications such as malunion, non-union, reduced range of motion, and muscle strength. This case report presents a multidisciplinary approach to the physiotherapeutic management of a DRF treated with closed reduction internal fixation using K-wires. The rehabilitation protocol incorporated matrix rhythm therapy (MRT), a novel therapeutic technique, in combination with targeted therapeutic exercises. The study outlines the patient\'s journey from injury to recovery, detailing the integration of MRT sessions alongside conventional physiotherapy exercises. The comprehensive rehabilitation aimed to enhance pain relief, restore range of motion, and improve functional outcomes. The case highlights the synergistic benefits of incorporating MRT into traditional rehabilitation strategies through assessment, personalized treatment planning, and regular progress evaluations. The outcomes underscore the potential of this combined approach in optimizing the recovery process.

BACKGROUND: Spontaneous rupture of the extensor pollicis longus (EPL) tendon following both nonoperative and operative treatment of distal radius fractures has been well described.
OBJECTIVE: The purpose of this study was to assess long-term outcomes of extensor indicis proprius to EPL tendon transfers for patients following distal radius fracture and EPL tendon repair.
METHODS: Retrospective case series focusing on long-term clinical outcomes.
METHODS: A retrospective review was conducted for patients who sustained a distal radius fracture and subsequently underwent extensor tendon transfer from 2005-2015 at a private practice center. Outcome measures including index finger (IF) metacarpophalangeal (MCP) and thumb interphalangeal (IP) active range of motion (ROM), digital extension against resistance, subjective complaints, and QuickDASH scores were recorded at final follow-up.
RESULTS: Seven patients were included in the study. There were six females and one male subject, mean age of 54 ± 13 years at injury of EPL, and 5/7 involved the left upper extremity. For isolated function, 7/7 (100%) patients had isolated, active IF MCP extension, 6/7 (86%) could extend IF MCP and thumb IP against resistance. Mean IF MCP extension was 1° ± 2°, mean IF MCP flexion was 89° ± 2°, mean thumb IP extension was -5° ± 4°, and mean thumb IP flexion was 67° ± 15°. Mean QuickDASH score was 16 ± 14.
CONCLUSIONS: This series shows good long-term functional and patient reported outcomes in patients following extensor indicis proprius to EPL tendon transfers at a single center.