When A "simple Fracture" Turns Out To Be More Problematic - Page #1
 

Author: Christopher Huckle, DO
Co Author #1: David Postelnek, MD - ER
Co Author #2: David Dromsky, MD - Ortho
Editor: Charlie Michaudet, MD
Senior Editor: Margaret Gibson, MD

Patient Presentation:
A 29 year-old Caucasian male presented to the emergency department (ED) with complaint of intense pain and decrease function in his left hand/wrist. Symptoms started initially after a dirt-biking accident 2 days prior to presentation. The patient went to a local Urgent Care and was diagnosed with a "simple fracture". 18 hours later he presented with severe pain, swelling and loss of function.

History:
A 29 y/o white male who had a dirt biking accident two days prior to presentation at the Emergency Department. He was initially seen at a local Urgent Care where one X-ray was taken and he was told he had a "simple fracture". He then had a splint placed and was told to follow up with either his PCP or an Orthopaedic physician, however the patient did not have insurance or any source of income. The next day, the day of presentation, he woke up with increasing pain, swelling, and noticed "a weird feeling" in his hand which was not present the day prior. When he presented to the ER, 18 hours after initially visiting the Urgent Care, he was complaining of extreme and increasing wrist pain, restricted motion and new onset numbness in all of his fingers of his left hand. When asked, he is unsure exactly how he fell on his hand but knows he was going at least 45mph when he fell and he tried using his hands to brace his fall.

Physical Exam:
GENERAL - Well developed, well nourished, young white male who is sitting up in bed, guarding his left wrist, appearing in moderate distress
HEENT - Normocephalic, atraumatic
CARDIO - Tachycardic, S1 and S2 audible; 2+ pulse palpated of the left wrist. Sluggish capillary refill time (>3 seconds) of the digits of the left hand
PULM - Clear to auscultation bilaterally
SKIN - Dorsal swelling of the left wrist; Digits of the left hand appeared mottled. Digits of the left hand are cool to touch comparatively to digits of the right hand
MSK - Tender to palpation over the carpus but not over the metacarpals or the digits. Range of motion was limited by pain both actively and passively, however patient was observed flexing and extending it on his own. 2/5 grip strength appreciated
NEURO - Sensation to light touch preserved of the left hand. Digits in median distribution had decreased sensation.

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