Fall On Outstretched Hand: Image Case

[Reasonable Rascal]

An eMedicine.com image case, #18.

BACKGROUND

A woman presents to the hospital with pain in her right wrist caused by a fall on her outstretched hand. On examination, swelling and tenderness are noted in the distal forearm. The classic dinner-fork deformity is recognized.

Hint

Fracture types are difficult to memorize. However, this fracture has several types; the most important of these to recognize is IIA because anything more serious requires immediate referral to an orthopedic surgeon. Visualizing the anatomy is helpful in identifying possible associated injuries.
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What is the diagnosis?

RR

[tangent]

Colls

-t

[themadmedic]

:kool:


Ouch!



Looks like a colle's Fx to me...

[Reasonable Rascal]

Colles fracture: A Colles fracture is an extension injury of the distal forearm. The basic types are classified according to their involvement, as follows: I, extra-articular; II, radiocarpal joint; III, radioulnar joint; and IV, radiocarpal and radioulnar joints. Each type is further classified as subtype A if it involves a radial fracture and as subtype B is it involves an ulnar fracture. For example, a type IIA Colles fracture is a distal radial fracture with radiocarpal joint involvement. The normal radiocarpal joint is angled 23° in the ventral direction. Dorsal angulation of the radiocarpal joint results in poor functional recovery with inadequate reduction. Approximately 60% of all distal radial extension fractures are accompanied by ulnar styloid fractures, and 60% of ulnar styloid fractures are associated with fractures of the ulnar neck. Carpal fractures, distal radioulnar subluxation, flexor tendon injuries, and median or ulnar nerve injury may be other associated injuries. Abnormal median nerve function requires an assessment of the pressure in the carpal canal pressures to differentiate acute carpal tunnel syndrome from median nerve contusion. Type IIA or less serious Colles fractures can be managed with dorsal and palmar long arm splints with the wrist in 15° of flexion and with 15° of ulnar deviation. Prompt orthopedic follow-up care is necessary. All other fractures require consultation with an orthopedic surgeon on an emergency basis.
Reference: Simon R, Koenigsknecht S. Emergency
Orthopedics: The Extremities. 3rd ed. Norwalk, Conn: Appleton & Lange; 1996:136-42.