Case history
Case history #1
A 62-year-old woman presents to the emergency department with a swollen left wrist. She reports a history of tripping over when walking downstairs and landing on her left hand. She is post-menopausal, and her medical history includes osteoporosis for which she is receiving calcium and vitamin D supplements. On examination, there is marked tenderness over the distal radius. Although range of motion is limited, there is minimal deformity.
Case history #2
A 27-year-old-male basketball player presents to the emergency department following an awkward landing in which he landed on his right hand. He was unable to continue playing and reports that his right wrist became immediately swollen. On examination, the patient's right wrist is swollen with marked 'dinner fork' deformity. There is tenderness over the distal radius and decreased sensation in the distribution of the median nerve.
Other presentations
Fractures of the distal radius can sometimes be associated with open wounds. Irrespective of age, an open wound usually suggests a higher-energy injury.[9]
In a high-energy fracture, patients may report numbness affecting the radial three digits, suggesting acute median nerve compression (carpal tunnel syndrome). Numbness of the ulnar two digits, suggesting ulnar nerve compression, is less common. If these symptoms are present, then urgent reduction of the fracture is recommended. If the symptoms do not resolve, fixation of the fracture and nerve decompression should be considered.
Displaced fractures that have not been reduced may cause considerable soft-tissue swelling associated with blistering of the skin around the wrist. Patients with high-energy injuries can also have associated swelling of the forearm and in some instances this may present with features of a compartment syndrome.
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