Forearm Case #4

History and Physical52yo female presents

to ED after slipping and falling forward on outstretched hand. Pt had obvious deformity to dorsal right wrist, but no obvious laceration. Pt states she fell on her extended hand as she was trying to break her fall. She denies any other injuries, no LOC.

T 98.8 P 88 BP 156/78 O2 99%

Gen- in obvious pain but NAD

MSK obvious deformity to dorsal wrist, TTP dorsal wrist. 1+ radial pulse RUE, ROM limited 2/2 pain in right wrist. No laceration

Neuro- 5/5 motor in all extremities except right wrist, which is limited by pain. Sensory nl throughout except for slight paresthesia over thenar eminence.

Radiographs

Diagnosis: Colles’ Fx

Distal Radius Fracture, with dorsal displacement/angulation of distal fragment. Referred to as “Dinner Fork Deformity”

Pain control Emergent Ortho consultation for all open fx or if radius unable to

be reduced Prompt reduction necessary for:

Intra-articular step-off >1 mm

Radial inclination <15 degrees

Volar tilt less than neutral (0 degrees) Shortening or loss of radial length greater than 2 mm as compared

with the opposite side Urgent ortho consultation for the following, b/c los of reduction is

frequent complicated fractures with significant displacement (more than 20

degrees of dorsal angulation), marked dorsal comminution, intra-articular extension

Sugar-tong splint if indicated (d/c with prompt ortho f/u)

ED Managment

Most common wrist fractureUsually caused by FOOSH with extended

wrist, often in seen in elderlyComplications of improper reduction include

arthritis of wrist jointNeurovascular exam important, for median

nerve injury possible

Pearls

More Images

http://rcpilibrary.blogspot.com/2010/12/winter-weather-and-colles-fracture.html

http://www.radiologyassistant.nl/en/476a23436683b

http://www.worldortho.com/dev/index.php?option=com_content&task=view&id=1116&Itemid=430

http://www.wheelessonline.com/ortho/colles_frxRosen’s emergency medicine : concepts and

clinical practice / editor-in-chief, John A. Marx ; senior editors, Robert S. Hockberger, Ron M. Walls ; editors, James G. Adams ... [et al.].—7th ed.

References