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 52yo female presents to ED        T 98.8 P 88 BP 156/78 O2
  after slipping and falling         99%
  forward on outstretched           Gen- in obvious pain but
  hand. Pt had obvious               NAD
  deformity to dorsal right
  wrist, but no obvious             MSK obvious deformity to
  laceration. Pt states she fell     dorsal wrist, TTP dorsal wrist.
  on her extended hand as she        1+ radial pulse RUE, ROM
  was trying to break her fall.      limited 2/2 pain in right wrist.
  She denies any other injuries,     No laceration
  no LOC.                           Neuro- 5/5 motor in all
                                     extremities except right wrist,
                                     which is limited by pain.
                                     Sensory nl throughout except
                                     for slight paresthesia over
                                     thenar eminence.
Distal Radius Fracture, with dorsal displacement/angulation of distal
fragment. Referred to as “Dinner Fork Deformity”
 Pain control
 Emergent Ortho consultation for all open fx or if radius unable to be
  reduced
 Prompt reduction necessary for:
    Intra-articular step-off >1 mm
    Radial inclination <15 degrees
    Volar tilt less than neutral (0 degrees)
    Shortening or loss of radial length greater than 2 mm as compared with
     the opposite side
 Urgent ortho consultation for the following, b/c los of reduction is
  frequent
    complicated fractures with significant displacement (more than 20
     degrees of dorsal angulation),
    marked dorsal comminution,
    intra-articular extension
 Sugar-tong splint if indicated (d/c with prompt ortho f/u)
 Most common wrist fracture
 Usually caused by FOOSH with extended wrist, often
  in seen in elderly
 Complications of improper reduction include arthritis
  of wrist joint
 Neurovascular exam important, for median nerve
  injury possible
 http://rcpilibrary.blogspot.com/2010/12/winter-
    weather-and-colles-fracture.html
   http://www.radiologyassistant.nl/en/476a23436683b
   http://www.worldortho.com/dev/index.php?option=c
    om_content&task=view&id=1116&Itemid=430
   http://www.wheelessonline.com/ortho/colles_frx
   Rosen’s emergency medicine : concepts and clinical
    practice / editor-in-chief, John A. Marx ; senior editors,
    Robert S. Hockberger, Ron M. Walls ; editors, James G.
    Adams ... [et al.].—7th ed.

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Colles’ fracture (1)

  • 1.
  • 2.  52yo female presents to ED  T 98.8 P 88 BP 156/78 O2 after slipping and falling 99% forward on outstretched  Gen- in obvious pain but hand. Pt had obvious NAD deformity to dorsal right wrist, but no obvious  MSK obvious deformity to laceration. Pt states she fell dorsal wrist, TTP dorsal wrist. on her extended hand as she 1+ radial pulse RUE, ROM was trying to break her fall. limited 2/2 pain in right wrist. She denies any other injuries, No laceration no LOC.  Neuro- 5/5 motor in all extremities except right wrist, which is limited by pain. Sensory nl throughout except for slight paresthesia over thenar eminence.
  • 3.
  • 4. Distal Radius Fracture, with dorsal displacement/angulation of distal fragment. Referred to as “Dinner Fork Deformity”
  • 5.  Pain control  Emergent Ortho consultation for all open fx or if radius unable to be reduced  Prompt reduction necessary for:  Intra-articular step-off >1 mm  Radial inclination <15 degrees  Volar tilt less than neutral (0 degrees)  Shortening or loss of radial length greater than 2 mm as compared with the opposite side  Urgent ortho consultation for the following, b/c los of reduction is frequent  complicated fractures with significant displacement (more than 20 degrees of dorsal angulation),  marked dorsal comminution,  intra-articular extension  Sugar-tong splint if indicated (d/c with prompt ortho f/u)
  • 6.  Most common wrist fracture  Usually caused by FOOSH with extended wrist, often in seen in elderly  Complications of improper reduction include arthritis of wrist joint  Neurovascular exam important, for median nerve injury possible
  • 7.
  • 8.  http://rcpilibrary.blogspot.com/2010/12/winter- weather-and-colles-fracture.html  http://www.radiologyassistant.nl/en/476a23436683b  http://www.worldortho.com/dev/index.php?option=c om_content&task=view&id=1116&Itemid=430  http://www.wheelessonline.com/ortho/colles_frx  Rosen’s emergency medicine : concepts and clinical practice / editor-in-chief, John A. Marx ; senior editors, Robert S. Hockberger, Ron M. Walls ; editors, James G. Adams ... [et al.].—7th ed.