1. Mr G Shyamalan Consultant Hand Surgeon HEFT

2.  Understanding the radiograph  Classification  Imaging and consent  Approach  Surgical case based discussion  Classic volar plate  Conclusion

11.  Colles

12.  Smiths and Bartons

13.  Chauffeur’s and Lunate die punch

14.  Frykman’s

15.  Melone’s

16. AO – Too complex Mayo – Extra/Intra-articular Reducible/Irreducible Fernandez – mechanism classification

17. Fragment Specific – Robert Medoff (intra- articular fractures). Radial styloid, dorsal wall, impacted articular fragments, dorsal ulna corner (die-punch), volar rim fragment (tear drop)

18.  Daniel Rikli & Pietro Regazzoni  Lateral – length and alignment  Intermediate – weight bearing and notch  Medial - rotation

19.  Low energy Vs High Energy  Normal Vs Osteoporotic  Dominant Vs Non – Dominant  Occupation and Functional Demands  Soft tissues (skin, nerves, tendons)  Pre-morbid conditions including MTS  Patient choice!  Fracture patterns and mechanism  Ulna fracture or carpal injury  Timing of consult

20.  Continued pain  Malunion  Infection  Stiffness  Chronic regional pain syndrome (500mg Vitamin C daily for 6 weeks)  Nerve/Vessel/Tendon Injury  Non-union  Instability carpus and ulna  Removal of metal work  Carpal Tunnel Syndrome

21.  Bring the kitchen sink!  Volar plates, dorsal straight plates, k-wires, Ex-fix, hand plating system

22.  Volar Henry’s releasing brachioradialis  Dorsal  Combined

23.  Volar plate  Dorsal plate  Fragment specific  Percutaneous Wires  Bridge plating  Ex-fix  ? Arthroscopic assisted  Bone graft or bone graft substitute  Bit of everything  Plan for a two stage?!

32.  Have an assistant who knows what they are doing  Traction the fracture closed  Open and Reduce +/- K wire  Put plate on shaft and gliding hole screw and screen  Plate can be rotated and pushed up or down depending on xray  Fill ulna holes distally, check lateral and then put in radial ones and complete proximally

33.  Don’t go bicortical distally  Check screw length on xray  Angle screws out of joint

34.  Don’t be afraid to put a K-wire and a plate on the radial styloid  If in doubt do a carpal tunnel decompression  Always release brachioradialis  If problems with dorsal fragment reduction, put in screws distally first and reduce fragment onto shaft  Continuous traction or Ex-fix can help with fixation  Multi-fragmentary fractures, intra-articular fractures try bridge plating

35.  Look at scapho-lunate interval on both wrists  Screen in radial and ulna deviation with sometimes compression  Look at ulna position, stress views and examine other side  Have no issues about implant removal  If in doubt do nothing and send to specialist