Case 9 Distal radial fracture Case 9 learning objectives: Discuss wrist function as an outcome and operative vs nonoperative care Recognize and manage a patient with dementia and describe how to get patient consent in this situation List and recognize the risk factors for delirium AOTrauma Course Fragility Fractures and Orthogeriatrics

Case description 74-year-old man Fell in the bathroom during a holiday at a resort with his wife

X-rays

Medical history Dementia Risk factors for delirium Discuss the problem of getting consent in patients with dementia and the difference between the wrist fracture and the hip fracture. Discuss the risk of delirium and options for nonpharmacological and pharmacological prevention.

What is the ideal management? Surgical fixation of the hip? What about the distal radius? Nonoperative vs surgical treatment

Post manipulation and reduction Reconsideration of options? Nonoperative or surgical?

If surgical option considered Discuss: Approach Implant options Ulna styloid–does it need fixation? Carpal tunnel release–is it required?

Intraoperative images

Postoperative images

Take-home messages Nonoperative managed Colles fractures have high rates of loss of reduction but equal wrist function at 1-year follow-up In active individuals, fixation is recommended to start early mobilization and weight bearing In ipsilateral lower limb fractures, upper limb stability with fixation will enhance ambulation with walking aid Patients with dementia are at high risk for delirium Nonpharmacological prevention is essential Getting consent could be very difficult, team responsibility is helpful

Thank you Return to list of cases End of case 9