History and exam
Key diagnostic factors
common
history of trauma or osteoporosis
wrist pain
The degree of pain varies according to the individual, and the mechanism of injury, as well as the type of fracture. Pain is also a feature of compartment syndrome, but it is out of proportion to the associated injury and occurs on passive movement of the muscles of the involved compartments.[30]
tenderness over the distal radius
This is elicited over the distal radius and the ulna, as well as the carpus.
swelling
Most fractures, except for the incomplete or unicortical fractures, will be associated with variable degrees of swelling.
Other diagnostic factors
common
deformity
In a displaced Colles fracture, the wrist may show the typical "dinner-fork" deformity when viewed from the side. In other wrist fractures different types of deformity may also be noticed.
uncommon
tenderness in the anatomic snuff-box
Suggestive of a scaphoid fracture. Tenderness in the anatomic snuff-box is not common in patients with a distal radius fracture.
numbness in the fingers
In patients with high-energy injury and displaced fractures, numbness may often be a presenting symptom, commonly affecting the radial three digits (median nerve distribution). Numbness of the ulnar two digits, suggesting ulnar nerve compression, is less common.
hypoesthesia
In patients who complain of numbness in the fingers, hypoesthesia can be elicited in the distribution of the median nerve.
open wound
High-energy injuries can be accompanied by open wounds. These are most commonly seen on the volar surface of the wrist or over the distal ulna.
absent pulse
Absent pulses are usually due to systemic hypotension, arterial occlusion, or vascular injury.[30] Note that pulses are normally present in compartment syndrome.
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