Name That Fracture

[Reasonable Rascal]

http://www.emedicine.com/shared/pub/xrotw/0001.jpg

Can you identify this fracture? The ER physician and the radiologist disagreed on the proper term.

RR

[tangent]

Monteggia? hmm... no that would be a dislocation by the elbow, so... Galeazzi?

I don't know! - and you would post this 12 hours after I returned the book on orthopedics I'd checked out of the library! :sad:

[Craig]

Ulna styloid # + Distal radius # with volar displacement/angulation = Smiths #. Complicated because of the multiple fragments and intraarticular involvement

Possibly a crack through the scaphoid, hard to tell from the film

Is there a trick here RR ?

cheers

Craig

[Reasonable Rascal]

No trick save that as I say the radiologist and the ER doc disagreed on what to call it. The radiologist was incorrect, BTW. I'll supply the answer in a day or so after folks have a chance to respond.

RR

[RESQDOC]

Ditto Craig. Often misnamed a Colles (which is displaced the other direction = dorsal) or
Barton fracture (which involves the articular surface.)

Scaphoid and Capitate both look suspicious. Hard to say, I’m operating on a really crappy
monitor today.

[Reasonable Rascal]

Gentlemen, I am happy to say you are correct. The radiologist in this case did identify it as a Colles fracture whereas the ER doc correctly called it. The patient reportedly fell onto their outstretched hand, which resulted in the injury seen.

RR

[tangent]

how about some discussion/tutorial on reading X-Rays? - what in the above are we looking for and what is significant?

what about differences in Tx for the different types of fractures/disslocations?

how would you diagnose/treat this injury if you didn't have X-Rays?

[Reasonable Rascal]

Look at the overall radiograph. Pay attention to the AP (full on) view. See the distortion to the outside left? You can see where there would be a bulging in the skin itself. First indication there might be a fracture involved. The soft tissue is very clearly defined in this pic, so well defined you can see the "lines" in the palm and the nails in their beds. Excellant study model.

Next the larger bone on the right. I would use palpation to ascertain loose fragments. In this case it ought to be fairly obvious just by feeling. Any movement would likely result in crepitus, which is the crackling/grating sound caused by bone fragments rubbing together.

The overall angle of the hand to the arm is also canted rather than straight as it should normally appear. The cant is modest but exaggerated by the deformity on the outer apsect at the wrist.

Docs, what else am I missing here?

RR