Ms.c continued to complain of numbness in her palm and middle finger,and her pain wasn't well controlled with oral oxycodone/acetaminophen. The nurse obtained a prescriphen from the surgeon for morphine sulfate I.V. Every 2 hours as needed for pain management. Ms.C pain level decreased from the 7/10 to 4/10,but she continued to complain of numbness in her palm and middle finger. The surgeon evaluated her and told the nurse that he believed the numbness was due to some edema around the median nerve and that it would resolve once the edema subsided.
The next morning, predischarge repeat PA and laterat radiographs of the right warst revealed loss of reduction of the fracture. The surgeon decided to proceed with an open reduction with internal fixation(ORIF)
Ms.c was brought to the OR, where the anesthesia provider performed a Bier block after the arm was exsanguinated using an elastic bandage. A pneumatic tourniquet was placed around the midhumeral portion of the right arm.
Using a volar incision, the surgeon explored the fracture and carpal tunnel, noting that the median nerve was compressed. Finding a previously undetected nondisplaced ulnar stylord fracture,the surgeon performed a carpal tunnel release,applied a volar plate with screws to the DRF,and pinned the ulnar styloid fracture.
The post-ORIF films revealed good reduction and alignment,and the posterior splint with elastic bandage wrap was reapplied. After an uneventful recovery in the postanesthesia care unit, Ms.C was transferred to the orthopedic unit. Her wrist pain was well managed with a pattent-controlled analgesia (PCA) pump, and the palm and middle finger numbness resolved. After a social service consultation,Ms. c was discharged home in her sister's care 3 days after her fall.