1. 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

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

3. X-rays

4. 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.

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

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

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

9. Intraoperative images

10. Postoperative images

11. Take-home messages
Nonoperative managed Colles fractures have high rates of loss of reduction but equal wrist function at 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

12. Thank you
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End of case 9