Dr. Timothy K. Durnin - 8/26/2007

Question
My 8 year old daughter fractured her distal radius on the 4th of july.  It was a transverse nondisplaced fracture.  On Tuesday she got her cast taken off.  The x-rays now show a significantly angled fracture of the distal radius.  The findings of the newest xrays say: There is a healing fracture of the distal radius with significant dorsal angulation of the distal fracture fragment.  The distal bones as osteoporotic. -  Her orthopedic wants her to go for a consultation to see what to do.  Can you please explain the xray results and how it changed so much while she was in the cast.  I have seen the xrays and the xrays show the angulation is around 40 degrees.  She has little R.O.M.  Her wrist is also still swollen in spots.  
Thank you so much.

Answer
Hi Karen,

The Ortho may have dropped the ball on this one. You have to get another surgeon (not the freind of his he recommended you to) on it as soon as possible. The osteoporotic distal fragments are typical and will get more dense with bone when stressed (normal). The dorsal angulation should have been caught with follow up films 2 weeks after casting, this could be considered negligence if your daughter didn't re-injury the area, like falling again on it. Sounds like open reduction with k-wire or ilizarov  may be required.

http://www.vardaan.net/ilizarov.htmfixation

This is a surgical procedure to regain proper apposition and alignment. This should have all been unnecessary; either the Ortho was rushed or insurance was an issue. Either way there is little excuse for this. I would get a lawyer.

Good luck!

Dr. Timothy Durnin
drs.chiroweb.com