Radiology Review

The Unintended Off-road Experience

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The Unintended Off-road Experience

A 70-year-old woman is brought to the emergency department by EMS after being involved in a motor vehicle collision. She was a restrained driver in a vehicle that was hit by a tractor-trailer, causing her vehicle to go off the road and hit the guardrail. She does not recall if the airbag deployed, and she believes she momentarily lost consciousness. She is complaining of pain in the head and the right wrist.

Her medical history is significant for mild (controlled) hypertension. Primary survey reveals an elderly female who is awake, alert, and oriented and in mild distress. Her vital signs are stable.

The patient has a small laceration on her face. Her right wrist is moderately swollen, and she has decreased range of motion. There is also moderate tenderness to palpation. Pulses are good, as is capillary refill time in the fingernail bed.

Radiograph of the right wrist is obtained (oblique view shown). What is your impression?


The Unintended Off-road Experience


A moderate amount of soft-tissue swelling is evident. There is also a fracture of the distal radius and an avulsion fracture of the triquetrum. The latter is the second most commonly fractured carpal bone after the scaphoid. Triquetral fractures usually result from a hyperflexion injury.

The patient’s wrist was immobilized in a splint, and referral to a hand surgeon was coordinated.

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