Complex distal radius fracture (CDRF) with median nerve injury management using one-stage distraction bridge plate fixation (DBPF) without nerve exploration allows nerve function recovery: a case report

Background: Complex distal radius fracture (CDRF) associated with median nerve injury is rarely reported due to low incidence or low recognition rate. Thus, we reported the outcome of using distraction bridge plate fixation (DBPF) in managing CDRF associated with median nerve injury without volar nerve exploration.
Case description: We reported a 67-years old male who sustained pain in the right wrist with dorsal angulated deformation following a fall on an outstretched hand two hours before being admitted to the emergency department. The patient also complained of numbness in all of the fingers except the little finger of the right hand. Posteroanterior (PA)/right lateral X-rays showed grossly dorsal displaced of the comminuted distal radius fracture associated with ulnar styloid avulsion. The diagnosis was a CDRF associated with median nerve injury. He underwent surgery in an emergency setting with DBPF on the dorsal side without opening the fracture site guided by an image intensifier. Early mobilization was started as the patient could tolerate the pain, and neuromuscular electrical stimulation was given twice a week after surgery. Plate removal was done six months after surgery and continued with a range of motion exercise of the right wrist.
Conclusion: It is important to consider the anatomical reduction without additional soft tissue trauma by opening the fracture site and the early emergency surgery decision based on physical examination in CDRF management. The stable fixation allows axonal regeneration after median nerve injury, proved by good nerve functional outcomes. DBPF is suitable for post-operative wound care and decreases costs compared to staged fixation surgery and volar nerve exploration. However, we still need to further investigate this procedure through higher comparison studies.