could POP position post radial ORIF cause/contribute to failure of metalwork?

[lordralf]

hi guys,

i have a friend who had an orif of radial fracture. She was in a back slab for two weeks and then placed in a pop for 5 weeks in approx 45degrees flexion.
at her f/u appt she found the metalwork had failed and the distal radial fragment had migrated dorsally inline with the carpals. She since had to have a further orif. since then she found out the operating surgeon for the 1st op had requested 2 weeks in back slab then to be placed in neutral for 2 further weeks - this was obviously not followed. she has asked my advice as to whether being kept in flexion could have caused metalwork failure or at least contributed to it.. im not 100% sure..it seems likely that it could have but i would really appreciate further opinions/clinical reasoning as to why it could or couldnt have affected it....thanks everyone

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[physiobob]

Your description is a little vague. Was the wrist in 45 degrees or the elbow in 45 degrees. I am thinking the wrist? I would not think that the position would be the factor involved here. More likely the patient moving the joing around to much post the surgery. A back slab isn't always that supportive and there are a number of things one needs to ensure are done to maintain the position. The 45 degress for the longer period would just have perhaps been overkill leading to some wrist stiffness which might have been lessened if the wrist was placed back in neutral following.

Overall my opinion would be that we couldn't advise on this one as there are so many factors that could be involved. The cast position in the second 2 weeks is perhaps least likely.