Forearm Case #5

History and Physical68 yo female presents

after slipping and falling while getting out of the shower. Pt fell forward onto her outstretched hand, with her wrist extended. Pt complains of extreme pain in her left wrist, and denies hitting her head or any other injuries.

T 97.6 P 98 BP 159/86 O2 97%

Gen: In obvious pain but NAD

MSK- obvious dorsal deformity/swelling to right wrist, limited range of motion in right wrist, 1+ radial pulse

Neuro- limited flexion/extension right wrist, nl sensation throughout

Radiographs

Diagnoses: Barton’s Fracture

Distal radius fracture w/ dislocation of radiocarpal joint

Pain ControlReduction of fracture, usually under

conscious sedationOrtho consult needed, as non-op treatment

usually failsStability of reduction of dorsal Barton fx is

best obtained with  wrist extension to take advantage of intact volar carpal ligament

ED Management

Most common fx dislocation of the wrist joint;    - comminuted fx of distal radius may involve either anterior or posterior cortex and       may extend into the wrist joint

Fx dislocation or subluxation in which the rim of distal radius (dorsally or volarly) is displaced with the hand and carpus;    - it often occurs along with a radial styloid frx    - it differs from Colles' or Smith's Fracture in that the

dislocation is the most striking radiographic findingMore common for distal fragment to be displaced

dorsally, although it can dislplace volarly also (volar Barton’s fx)

Pearls

More Images

http://www.wheelessonline.com/ortho/dorsal_bartons_fracture_dorsal_shearing_frx

http://www.freebase.com/view/en/distal_radius_fracture

http://myradnotes.wordpress.com/2008/06/http://www.radiologyassistant.nl/en/

476a23436683b

References