Staged external fixation and dorsal mini-plate fixation for a distal radius fracture with an overlying volar burn

Burns combined with fractures are uncommon and become particularly challenging when the burn overlies the surgical corridor. We report a 51-year-old woman with an intra-articular distal radius fracture and an overlying deep volar ulnar wrist burn (deep partial-thickness to full-thickness) after jumping from a second floor during a house fire. A spanning external fixator was applied through unburned skin on the day of injury while the burn was managed conservatively by plastic surgeons. Ten days later, definitive fixation was performed through an intact dorsal approach with articular reduction, bone substitute filling, and fragment-specific fixation using two low-profile 2.0-mm dorsal mini-plates; the extensor retinaculum was interposed at closure to reduce tendon irritation. Although intraoperative stress testing after plating showed no gross instability, the spanning fixator was retained for 4 weeks because construct rigidity was a concern and volar splinting would interfere with burn dressing care. At 14 months after injury (3 months after plate removal), the patient had good wrist motion, 80.3% grip strength versus the contralateral side, PRWE 16.5, and QuickDASH 20.5, without infection or pin-tract problems. Staged stabilization that avoids burned skin and uses a dorsal safe corridor may be a feasible option in selected patients while facilitating ongoing burn management.