CASE PRESENTATION COLLES.pptx
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A 61-year-old male presented to the emergency department with swelling, tenderness, and severe pain in his wrist after falling on an outstretched hand. On examination, he had swelling and a "dinner-fork" deformity of the wrist. X-rays showed a distal radius fracture. The fracture was reduced closed by an orthopedic resident and splinted. Distal radius fractures can be reduced in the emergency department if Colles or Smith fractures but Barton fractures require immediate orthopedic referral. Patients can be discharged if they have appropriate reduction, immobilization, follow-up arranged, and understand cast care instructions.
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CASE PRESENTATION COLLES.pptx
- 1. CASE PRESENTATION BY DR ZOHAIB
- 2. • 61 YEAR OLD MALE FELL ON OUTSTRETCHED HAND (FOOSH) WHILE HE WAS TAKING SOMETHING FROM THE TOP. HE PRESENTED TO THE ED WITH TENDERNESS , SEVERE PAIN, AND SWELLING IN THE REGION OF WRIST. ON PHYSICAL EXAMINATION HE HAS SWELLING AND “DINNER-FORK” DEFORMITY. NEUROVASCULAR EXAMINATION WAS NORMAL
- 3. DIFERENTIALS • DISTAL RADIUS ULNA FRACTURES, COLLE’S, SMITH (REVERSE COLLE’S FRACTURE, BARTON (INTRAARTICULAR). • DISTAL RADIOULNAR JOINT DISRUPTION. • CARPAL FRACTURES (SCAPHOID, LUNATE)
- 4. AP VIEW
- 5. LATERAL VIEW
- 6. REDUCTION • HAEMATOMA BLOCK PERFORMED BY INJ XYLOCAINE. • CLOSED REDUCTION DONE BY ORTHOPEDIC RESIDENT. • SUGAR-TONG SPLINT APPLIED.
- 7. POST REDUCTION X RAY
- 8. WHAT TO DO WITH DISTAL RADIUS FRACTURE • THE MEDIAN, ULNAR AND RADIAL SHOULD BE ASSESSED. • RADIAL AND ULNAR PULSES SHOULD BE EVALUATED. • TYPE OF FRACTURE BARTON, COLLES, SMITH. • COLLES AND SMITH CAN BE REDUCED IN ER WITH F/U IN ORTHO DEPT, BUT BARTON SHOULD BE REFERRED TO ORTHOPEDIC IMMEDIATELY.
- 9. SMITH CAN BE SOMETIMES DANGEROUS TO REDUCE IN ER
- 11. WHOM TO REFER • BARTON FRACTURE • OPEN FRACTURES, FRACTURE WITH COMPARTMENT SYNDROME OR NEUROVASCULAR COMPROMISE. • SMITH FRACTURE, IF DISPLACED. B/C IT IS MORE UNSTABLE THAN COLLES.
- 12. WHOM TO DISCHARGE • APPROPRIATE REDUCTION AND IMMOBILIZATION • ORTHOPAEDIC F/U ARRANGED • PAIN CONTROL MEASURES TAKEN ADEQUATELY • CAST OR SPLINT CARE INSTRUCTIONS SHOULD BE GIVEN AT DISCHARGE AND SHOULD BE ASSURED PATIENT UNDERSTANDS THEM.
- 13. • THANKYOU