# Intramedullary Plate Fixation and Viable Bone Allografting in a Complex Intra-articular Distal Radius Fracture Nonunion: A Case Report

## TL;DR

This case report describes a successful treatment for a complex wrist fracture nonunion using a combination of plates and bone grafting.

## Contribution

A novel surgical construct combining intramedullary plate fixation and viable bone allograft is proposed for distal radius nonunions.

## Key findings

- A dorsal spanning plate and intramedullary fragment-specific plate were used with viable bone allograft.
- The treatment accommodated patient refusal of bone autograft while addressing poor subchondral bone stock.
- The case highlights the importance of surgical ingenuity in treating complex nonunions.

## Abstract

In this report, we detail a 69-year-old female who sustained a comminuted intra-articular left distal radius fracture that failed to heal with bridge plate fixation. Given the patient’s poor subchondral bone stock and refusal of bone autograft, we designed a construct using a dorsal spanning plate and an intramedullary fragment-specific plate as a volarly placed strut in combination with viable bone allograft and cancellous bone chips to treat this nonunion. This case demonstrates an option for distal radius non-union treatment and highlights the importance of ingenuity that orthopedic surgeons should demonstrate when trying to accommodate patients’ wishes.