Treatment With an Osteochondral Graft From the Olecranon for a Fernandez Classification Type 4 Distal Radial Fracture

Fernandez type 4 distal radial fractures involve radiocarpal dislocation with an avulsion fracture of the articular margin, typically causing considerable instability because of ligament and joint capsule injuries. We present a 30-year-old man with a left distal radial fracture and dorsal radiocarpal dislocation because of a motor vehicle accident. Initial reduction, internal fixation, and ligament repair failed to prevent recurrent dislocation. A second surgery was performed to address a dorsal articular surface defect in the lunate fossa using an osteochondral graft from the olecranon tip, stabilized with Kirschner wires and an external fixator. Fixation was removed after 4 weeks, followed by range of motion exercises. At 3 months, graft union with good articular congruency was confirmed, with improved wrist function by 15 months. This case highlights the efficacy of olecranon osteochondral grafting for articular defects in unstable distal radial fractures, emphasizing the importance of early intervention and appropriate fixation for optimal outcomes.