Surgical Management

The patient was provided with a "clam-shell" anteroposterior thumb-spica splint that was custom fabricated by an occupational hand therapist. For the interval between the office evaluation and surgery, the patient was instructed to wear the splint at all times except to shower. Unlike a cast, a removable splint is less likely to cause skin problems prior to surgery, and the splint can be reused during the postoperative course.

Nonsurgical options included no treatment, immobilization in a cast or splint, and/or electrical stimulation. The surgical options included an anterior (palmar) Russe versus dorsal approach (Fig. 58—5), conventional nonvascularized bone graft (cancellous or corticocancellous) (Fig. 58—6) versus vascularized, pedicled bone graft from the distal radius, and fixation options including no fixation, Kirschner wires (K wires), or screw fixation. A vascularized distal radius corticocancellous

Distal Radius Bone Graft Sites

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