A delayed symptomatic presentation of DT unrecognised intraoperatively is a specific complication that needs to be recognised and treated appropriately. A high suspicion and vigilance can help discover and address delayed CSF leaks with no long-term sequelae.

A 54-year-old Caucasian woman presented with a 6 week history of periscapular pain and a T1 radiculopathy associated with Horner's syndrome. MRI of her cervicothoracic spine revealed an intervertebral disc herniation at the level of T1-2. During investigation she experienced some improvement in her symptoms and a conservative approach was pursued. At 6 months her pain and radiculopathy had resolved, and there was mild residual ptosis.

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Distal radius fractures predominantly affect two adult population groups: elderly patients with fragility fractures and young adults following high-energy trauma. These injuries represent 20% of all adult fractures, of which up to 50% have an intraarticular component. The development of posttraumatic arthritis following intra-articular fractures is well known, resulting in pain and functional impairment. Malunion causing articular step-offs leading to changes in contact stresses may result in degenerative changes. 1 For this reason the management principles of intra-articular fractures aim to achieve anatomic reduction and fixation to restore joint line congruity.One of the key focuses is the articular support of the carpal bones, with articular alignment and congruity thought to be most important in restoring pain-free wrist function.The main compromised joint in distal radial fractures is the radiocarpal joint, 2 but distal radioulnar joint (DRUJ) involvement is also frequently observed, particularly when the fracture involves the sigmoid notch. This can have damaging effects on upper limb function and increase the morbidity of the fracture. With patients in whom the DRUJ is involved or dysfunctional, restoration of normal anatomy is key, to enable free rotation to position the hand in space appropriately. Keywords► distal radius fracture ► distal radioulnar joint (DRUJ) ► hemiarthroplasty AbstractBackground Intra-articular distal radius fractures can have many complications, including radiocarpal osteoarthritis and distal radioulnar joint (DRUJ) dysfunction leading to pain and restricted wrist function. Case Description We describe the case of a 38-year-old patient who sustained a left distal radius intra-articular fracture, which was treated with volar plating. She developed pain from the radiocarpal joint as a result of intra-articular malunion and was listed for total wrist fusion. On the day of surgery this was converted to a Darrach procedure for minor DRUJ symptoms. This resulted in pain from the DRUJ as a result of instability, in addition to persisting radiocarpal arthritis pain. Due to her subsequent poor wrist function, she presented to the authors and underwent DRUJ arthroplasty with a proximally placed Scheker prosthesis to deal with her DRUJ symptoms and, later, a KinematX radiocarpal hemiarthroplasty for her radiocarpal symptoms. She remains happy with her outcome at 36-month follow-up. Literature Review The complications of the Darrach procedure include painful radioulnar convergence and wrist instability. The Scheker prosthesis allows restoration of stability of the DRUJ with good outcomes and 100% 5-year survival in one series. Sparing the midcarpal joint, the KinematX hemiarthroplasty allows preservation of the dart thrower's motion arc, which is key in many complex wrist movements and functions. Clinical Relevance This case highlights the negative consequences of distal ulna resection and shows both the Scheker and KinematX prostheses as viable, effective means to restore function to young,...

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