Description
This video transcript describes a complex case involving a 55-year-old female patient suffering from a distal radius fracture sustained while playing tennis. The patient underwent a closed reduction with k-wire fixation and casting, initially showing some loss of proper alignment following the procedure. Over the following months, she developed a clinical picture of Complex Regional Pain Syndrome (CRPS), leading to wrist stiffness and functional impairment.
As the patient continued her rehabilitation, she presented significant malunion and stiffness in her extremity, characterized by limited rotation and flexion. A corrective osteotomy was discussed to address the malunion, but there were concerns about triggering CRPS symptoms. The surgical approach involved placing a catheter for pain control and using a Continuous Passive Motion (CPM) machine post-operatively to preserve her rotational functionality. An extensive flexor tenolysis was performed during the corrective surgery, aiming to improve her range of motion.
Post-surgery, while the patient showed improvement in active finger motion, her flexion extension remained limited. The video discusses the decision-making process regarding the need for additional interventions and challenges encountered during surgery, including hardware deformation that affected the outcome. After further interventions, including a second surgery focused on flexor tenolysis and hardware removal, the patient regained improved functionality but continued to have residual issues with flexion.
The discussion concludes with insights into managing CRPS and the importance of multidisciplinary approaches, highlighting the intricacies of surgical decisions and patient-centered care in managing post-injury complications.