Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the affected arm placed on a radiolucent arm table to allow for intraoperative imaging and manipulation.

Anatomical surgical approach:  A longitudinal incision was made over the radial styloid. The extensor carpi radialis longus and brevis were retracted to expose the entry point. A guide wire was inserted through the radial styloid into the medullary canal under fluoroscopic guidance. Sequential reaming was performed, followed by insertion of an appropriately sized Foresight® intramedullary nail.

The surgeon noted that the use of an intramedullary nail effectively acted as an internal splint, preserving the biology of the fracture site while achieving stable fixation. The decision to avoid open reduction and internal fixation (ORIF) or external fixation was based on the intact soft tissue envelope and the non-emergent nature of the injury. The PIN palsy was attributed to neuropraxia from the concussive effect of the ballistic injury, not warranting immediate exploration.

Postoperative protocol:   Postoperatively, the patient was encouraged to begin early range of motion exercises to prevent stiffness and promote functional recovery. Weight-bearing restrictions were not applicable given the location of the injury.

Follow up:   Not specified.

Orthopaedic implants used:   A Foresight® Intramedullary Distal Radius Nail (Smith & Nephew, USA) was used for fixation