Abstract
Case: A 48 year-old male was treated by MIPO for a distal radius fracture. A subcutaneous hematoma was noticed on the second postoperative day, which gradually enlarged. Rehabilitation was interrupted by the pain emanating from the hematoma. The patient was referred to our hospital two months later. A 30×60×15 mm large immobile elastic-like firm mass was palpated on the palmar side of the wrist. Range of motion (ROM) of palmar flexion, dorsal flexion, radial deviation, and ulnar deviation were 40, −20, −5, and 10 degrees, respectively. Pronation and supination were 20 and 0 degrees, respectively. Grip power was 0 kg and tip-palm distance was 50 mm. Plain radiography revealed bone union. Removal of the implant and resection of the hematoma were undertaken. Six months postoperatively, ROM had improved in palmar flexion, dorsal flexion, radial deviation and ulnar deviation to 75, 45, 10, 10, 75, and 55 degrees, respectively. Tip-palm distance reached 0 mm.
Discussion: MIPO is a method of minimally invasive surgery to fix a fracture via a small incision. Hence, it is important to understand the local anatomy and the indication for intervention A closed procedure by MIPO might have damaged a blood vessel whilst inserting the plate, that lead to hematoma formation. Median nerve palsy may have been avoided if the hematoma had been removed promptly.
Conclusion: We experienced a patient with a median nerve palsy caused by a massive postoperative hematoma as a complication of MIPO for a distal radius fracture.
