A 45-year-old male presents to the emergency department with right wrist pain after falling on an outstretched hand while working in his yard. On examination, his right wrist is tender over the distal radius with no other deformities or neurological deficits. A chauffeur's fracture is suspected due to the mechanism of injury, which is an avulsion fracture of the radial styloid that often requires surgical fixation. Close orthopedic follow up is needed to properly evaluate and treat the injury.

2.  CC: wrist pain
 HPI: 45 yo right-handed male
presents to the ED s/p
mechanical fall complaining of
R wrist pain. Patient states that
he was working in the yard,
when he tripped over a shovel
and landed on his outstretched
R hand. He experienced
immediate throbbing pain to R
wrist worsened with movement.
He denies other injuries. He
denies weakness or sensory
changes in the extremity. Pain is
7/10 on scale. Event occurred
one hour prior to arrival.
VS: T: 97.9 P: 95 R:
18 BP: 156/87
Musculoskeletal: RUE:
wrist is tender over distal
radius. No snuffbox TTP.
No pain on axial loading.
No gross deformities.
2+radial pulse. 1+ulnar
pulse. <2sec cap refill in
all 5 digits. Normal
motor,sensory function of
median/radial/ulnar
nerves.

4. AKA: Chauffeur’s Fracture

5.  If obvious intercarpal injury, then emergent ortho
consult
 If no associated injuries, sugar tong splint and urgent
ortho f/u
 Requires Close Orthopedic evaluation because most
require ORIF

6.  Mechanism of injury:
 Direct blow to distal radius or fall onto outstretched hand,
often with compression of scaphoid against styloid fragment
 Chauffer’s Fracture
 Named because was common occurrence in chauffer’s who
experienced a backfire of the care while they were hand
cranking the engines of early cars
 Underlying pathology: Avulsion fracture with extrinsic
ligaments remaining attached to styloid fragment
 Associated injuries: often accompanied by intercarpal
ligamentous injuries (scapholunate dissociation, perilunate
dislocation)

8. Koval, K. et al. Handbook of Fractures. 4th Edition. 2010.
Northwestern University School of Medicine:
Emergency Medicine Residency Orthopedic Teaching
Files
http://www.feinberg.northwestern.edu/emergencyme
d/residency/ortho-teaching/
Wheeles Ortho online
textbook http://www.wheelessonline.com/
http://radiopaedia.org/articles/chauffeur-fracture