A 65-year-old woman with an 86-day-old improperly healed wrist fracture presenting with a “dinner fork” deformity was successfully managed using a minimally invasive needle-knife bone reduction combined with bone-strengthening herbal therapy.

Case ID: CHC-0053

Case Summary

This case describes a 65-year-old woman who presented with a severely deformed and immobile right wrist 86 days after a fall. Having initially dismissed it as a simple sprain and relying solely on topical oils, the fracture healed improperly. The original report documented a conventional diagnosis of an old distal radius fracture (malunion) and a TCM assessment of Bone Wilting (Gu Wei) driven by Qi and Blood deficiency with Liver and Kidney depletion. She was managed through a highly specialized integrative approach utilizing a small needle-knife to safely break the old callus, followed by traditional bone-setting manual reduction and internal herbal tonification.

Patient Presentation

• Patient: 65-year-old female (Surname: Li).
• Main Complaint: Right wrist swelling, deformity, and severe mobility restriction 86 days after a fall.
• History: The patient sought consultation on March 2, 2014. Exactly 86 days prior, she fell and landed on her right hand. Believing it was merely a sprained tendon, she self-treated at home using topical Wanhuayou (a traditional traumatology oil) and did not seek hospital care. Over two months later, the swelling and pain had not subsided. Her wrist had developed a visible deformity, her fingers were numb with a paralyzed pain, and she completely lost the ability to flex, extend, or rotate her wrist, nor could she form a fist.
• Physical Exam: The right wrist exhibited a classic “dinner fork” deformity. The distal forearm and wrist were swollen with localized circular tenderness. All five fingers were stiff in a semi-extended position and could not make a fist.

Examination and Diagnosis

• Conventional Diagnosis: 1. Old (malunited) fracture of the distal right radius; 2. Old fracture of the right ulnar styloid process. (X-rays confirmed osteoporosis, dorsal displacement of the fracture ends with external callus formation, and distal radioulnar joint separation).
• TCM Tongue and Pulse: The tongue was pale red with a thin, white coating. The pulse was stringy and fine (脉弦细).

TCM Assessment

The original practitioner interpreted the presentation as Bone Wilting driven by Qi and Blood Deficiency with Liver and Kidney Depletion (骨痿 – 气血两虚，肝肾亏损).

According to the holistic principles of yin and yang Chinese Medicine the Liver governs the sinews and the Kidneys govern the bones. Because the patient was elderly, she already had an underlying systemic depletion of Liver blood and Kidney essence (objectively confirmed by the X-ray showing osteoporosis).

When the trauma occurred, localized Qi and Blood stagnated. Because she delayed proper medical reduction for nearly three months, the stagnant blood and fluids solidified improperly, leading to a deformed, ineffective callus. This severe localized stasis blocked the meridians, cutting off nourishment to the hand, which directly caused the numbness, stiffness, and inability to make a fist. The pale tongue and stringy-fine pulse confirmed her foundational weakness paired with localized constraint.

Treatment Approach

The primary treatment principle was to perform a needle-knife bone-breaking reduction, unblock impediment, and strengthen the sinews and bones (针刀折骨整复，通痹强筋壮骨). The strategy required correcting the structural deformity without utilizing violent traditional re-breaking methods (which could shatter her osteoporotic bones), while simultaneously using herbs to accelerate proper healing.

Interventions and Herbal Formulas

• Needle-Knife Bone-Breaking Reduction (Surgical/Manipulative):
  • Under brachial plexus anesthesia and sterile conditions, the practitioner used a specialized, self-designed 2mm small needle-knife.
  • The blade was inserted percutaneously at the distal radius (carefully avoiding the extensor tendons) directly into the old fracture’s callus. The practitioner pried transversely 2-3 times to safely cut and break the improperly healed callus.
  • While two assistants provided balanced counter-traction, the surgeon used the needle-knife to pry apart the volar (palmar) side and thick callus, then removed the tool.
  • The surgeon then applied manual orthopedic reduction (palmar flexion and ulnar deviation) to properly realign the distal radius. The wrist was sterilized, bandaged, and secured in a standard small splint. Post-operative X-rays confirmed excellent alignment.
• Internal Herbal Formula (March 2, 2014): A 7-herb traumatology decoction to move blood and promote bone healing.
  • San Qi (Notoginseng, 10g), Tao Ren (Peach Kernel, 10g), Hong Hua (Safflower, 5g), Chi Shao (Red Peony, 10g), and Yan Hu Suo (Corydalis, 10g) aggressively invigorated blood, dissolved the old stasis, and stopped the pain.
  • Gu Sui Bu (Drynaria, 10g) and Di Huang (Rehmannia, 15g) specifically targeted the Kidneys to strongly stimulate the growth of new, healthy bone.
  • Administration: 3 doses, taken morning and evening.

Follow-Up

• Day 3 Post-Op: The patient underwent a dressing change. The fracture site was slightly swollen, but the needle-knife puncture site had no redness. An institutional Jie Gu Gao (Bone-Joining Paste) was applied externally, the splint was reapplied, and three more doses of the internal decoction were prescribed.
• Day 5 Post-Op: Wrist and finger flexion/extension had recovered remarkably well. She was discharged with 7 days of internal Jian Gu (Bone-Strengthening) Granules.
• Long-Term Follow-Up: At three weeks, the splint was removed, and she continued with topical pastes and internal granules. After two months of rehabilitation, a follow-up X-ray showed excellent alignment with abundant new callus formation, achieving full clinical healing.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the innovative integration of modern minimally invasive tools (the needle-knife/acupotomy) with traditional TCM bone-setting.

Treating an 86-day-old malunited fracture in a 65-year-old osteoporotic patient is notoriously difficult. The original practitioner notes that utilizing traditional manual “re-breaking” (折骨) requires immense physical violence, which causes severe secondary tissue damage, massive swelling, and risks shattering frail bones. By using a tiny 2mm needle-knife to precisely cut through the improper callus from the inside out, the practitioner released the structural tension with almost zero external trauma. This allowed for a gentle manual realignment, dramatically accelerating the patient’s functional recovery and proving the value of modernizing classical orthopedic techniques.

---

Source Original source: Zhanjiang Second Hospital of Traditional Chinese Medicine / Guangdong Provincial Administration of Traditional Chinese Medicine Original title: 【以案说医】招仕富：右桡骨远端陈旧性骨折针刀整复治疗验案 Practitioner: Professor Zhao Shifu (招仕富) Publication date: September 10, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation