Laparoscopic Complex Fascia Transfer

The case

The radius is the forearm bone on the thumb side. Its wide end at the wrist, the distal radius, forms most of the wrist joint, and it is one of the bones broken most often. A common pattern is the Colles fracture, where the end of the bone is pushed and tipped backward. Some breaks stay outside the joint; others split the joint surface into pieces. Thin bones from osteoporosis make these breaks more likely and harder to fix.

Many distal radius fractures can be set without a cut and held in a cast. Surgery is advised when the end of the bone is badly broken up or shifted, or will not stay in place. In an open reduction and internal fixation (ORIF), the surgeon opens the palm side of the wrist, lines the pieces back up and holds them with a thin plate on the front of the bone and screws that lock into the plate. X-rays during surgery check the position and make sure no screw enters the joint. Sometimes the tip of the other forearm bone, the ulna, is broken too and needs its own fixation.

The operation is usually done with the arm numbed by a nerve block, with general anesthesia, or with sedation, and a tight cuff on the upper arm keeps the area dry. Afterward the wrist rests in a splint. The stitches come out after about a week, wrist motion starts once the surgeon is sure the repair is stable, and a removable splint is worn for about six weeks, usually with a home exercise program or hand therapy.