Distal Radial Fracture

70 y/o F with h/o osteoporosis presents with acute onset wrist pain s/p fall on outstretched hand (FOOSH). Denies h/o peripheral vascular disease, previous wrist injury/surgery. Wrist swelling, but no open fracture/deformity or pain with palpation of anatomic snuff box. Appropriate capillary refill; motor/sensory function intact in region of median, radial, and ulnar nerves.

• Postero-anterior (PA), lateral, and oblique wrist views reveal distal radial fracture

• Pain control

  • Opiate naive: Administer 1 time dose 2.5 mg morphine IV if necessary

  • Calculated CrCl ≥ 30 mL/minute: Start naproxen 500 mg BID

• Apply sugar-tong splint allowing for full MCP flexion/extension

• Counseling

  • Pt instructed to elevate arm and apply ice to affected extremity

  • Pt encouraged to perform shoulder and finger range of motion exercises

  • Pt advised to seek medication attention if widespread discoloration or numbness/tingling develop in affected extremity

• Follow-up outpatient with orthopedics

Notes

• Pain with palpation of anatomic snuff box should raise suspicion for scaphoid fracture

• Obtain emergent orthopedic consult for

  • Open fractures

  • Development of neuropathy/vascular compromise