Photo Rounds

“Dinner-fork” deformity after fall

A 75-year-old woman sought care for wrist pain and swelling after she tripped on a rug at home and fell on her outstretched right hand. The patient found it difficult to move her wrist and hand, and her arm had a “dinner-fork” deformity. The patient had been postmenopausal for 15 years and had never taken hormone replacement therapy or bisphosphonates. The family physician (FP) ordered x-rays.

What's your diagnosis?


 

The FP diagnosed a Colles fracture, which is manifested by a distal radius fracture with dorsal angulation seen on the lateral view. Distal radius fractures are common—especially in postmenopausal women. The classic history is a fall on an outstretched hand.

In patients older than 40 years of age, there is a strong association with osteoporosis. Patients with low-impact distal radius fractures have higher rates of osteoporosis than age-matched controls without fractures.

Treatment is either operative or non-operative, based on the degree of displacement and the age of the patient. In one study, open reduction and internal fixation was compared to closed reduction and cast fixation in patients older than age 65 with an unstable displaced radial fracture. The investigators found that at 12 months, there was no difference in range of motion, pain, or function.

In this case, the FP placed a splint on the patient’s wrist and referred her to an orthopedist to discuss treatment options.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Chumley H, Usatine R. Distal radius fracture. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:605-610.

To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com

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