Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute wrist pain, swelling, and deformity following a fall on an outstretched hand (FOOSH). Reports immediate loss of function, localized tenderness, and paresthesia in the median nerve distribution. No history of prior trauma to the affected extremity.
Clinical Examination Findings
Inspection reveals characteristic "dinner fork" deformity (Colles) or "garden spade" deformity (Smith). Significant edema and ecchymosis present. Palpation demonstrates point tenderness over the distal radius. Neurovascular exam: distal pulses (radial/ulnar) intact, capillary refill <2 seconds. Sensory exam: intact to light touch, though median nerve compression symptoms may be noted. Range of motion severely limited due to pain.
Treatment Protocol
Immediate immobilization via sugar-tong or volar splint. Analgesia administered. Radiographic confirmation of fracture pattern obtained. If displaced, closed reduction under hematoma block or conscious sedation performed. Post-reduction neurovascular status reassessed. Orthopedic follow-up scheduled for definitive management (ORIF vs. casting).