Distal Radius Fracture — ABOS Oral Boards Preparation
What examiners expect and how to prepare
Clinical Scenario
A 58-year-old right-hand-dominant woman presents to the emergency department after a ground-level fall onto her outstretched right hand while walking her dog. She is a retired schoolteacher with well-controlled hypertension and osteopenia diagnosed two years ago. She reports immediate pain and deformity of the right wrist with inability to grip. On exam, there is a visible dorsal angulation deformity of the distal right forearm. The skin is intact. She has full digital flexion and extension with intact sensation in the median, ulnar, and radial nerve distributions. Radial pulse is 2+ and symmetric. There is mild swelling but no compartmental tightness.
AP and lateral radiographs of the right wrist reveal a dorsally displaced, comminuted intra-articular distal radius fracture with 20 degrees of dorsal tilt, 3 mm of radial shortening, and a 2 mm articular step-off involving the lunate fossa. The distal radioulnar joint appears congruent. There is no ulnar styloid fracture.
After discussion of operative and non-operative options, you performed open reduction and internal fixation with a volar locking plate through a flexor carpi radialis approach. Post-operative radiographs showed restoration of radial inclination, volar tilt, and articular congruity. The patient was placed in a volar splint and began gentle range of motion at two weeks.
What Examiners Look For
- Data gathering: Present this patient completely — age, hand dominance, functional demands, bone quality, and mechanism before jumping to imaging.
- Diagnosis: Systematic radiograph interpretation — radial inclination, volar tilt, radial height, articular congruity, and DRUJ assessment on every film.
- Indications: Clear rationale for operative fixation — which specific parameters (tilt, shortening, step-off) crossed your threshold, and what would have made this non-operative.
- Technical skill: Step-by-step description of the FCR approach, plate positioning relative to the watershed line, and how you confirmed articular reduction.
- Complications: What if the patient develops median nerve symptoms at six weeks? How do you distinguish carpal tunnel from plate prominence versus a missed acute carpal tunnel syndrome?
- Applied knowledge: What does the literature show regarding functional outcomes for intra-articular step-off greater than 2 mm in patients over 50?
- Outcomes: Describe your follow-up protocol — when do you image, when do you allow full activity, and what functional benchmarks do you use?
Common Pitfalls
- Failing to assess the DRUJ on every distal radius fracture — examiners will ask about stability testing.
- Not knowing your indications cold — if you cannot articulate why you operated (versus cast), you lose points across multiple dimensions.
- Citing specific paper titles or author names instead of discussing evidence trends.
- Forgetting to mention osteoporosis workup and treatment in a post-menopausal woman with a fragility fracture.
- Overexplaining surgical technique without being asked — answer the question, then stop.
Key Classifications
Related Scenarios
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