Post on 02-Jun-2015
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