Arm Injury A Case Discussion

Case PresentationPatient History

General Data

TO 14 year old male Lives in Palau Right-handed Informant: Patient, good reliability

Chief Complaint: Wrist Injury

History of Present Illness

Fall2nd floor of house ~ 20fthitting R hand, fully extended- on sandy surface(+) loss of consciousness

for a few seconds(+) deformity on R wrist(–) break in skin(–) bruising

8 days PTA

History of Present Illness

Consult at local hospitalX-ray revealed fracture of the distal radiusGiven TramadolDischarged (no ortho)

(-) Change in sensorium(-) Nausea, vomiting,

seizure(-) numbing of R hand

8 days PTA

Admission

Review of Systems

General: no weight loss, Cutaneous: no lesion, no pruritusHEENT: with occasional headaches

no rednessno aural/nasal dischargeno neck massesno sore throat

Cardiovascular: no easy fatigability, fainting spells, no palpitation

Respiratory: no cough, coldsAbdominal: no change in bowel movementGenitourinary: no change in urinationEndocrine: no polyuria, polydypsia, no heat/cold

intoleranceHematopoietic: no easy bruisability, or bleeding

Past Medical History

No asthma, hypertension, diabetes, allergies, heart disease, bone diseases

No maintenance medications No previous surgeries Does not recall previous

immunizations Hospitalized > 5 years ago 2o AGE

Family History

Diabetes Mellitus, Heart Disease No hypertension, asthma, cancer,

stroke, or allergies

Personal/Social History

1st year high school student Lives with his family in a 2 story

house in Palau Denies smoking, alcohol drinking,

and drug abuse

Case PresentationPhysical Exam

Physical Exam

General Survey Awake, active, and not in

cardiorespiratory distress Vital Signs

Febrile at 37.5oC RR 20 bpm HR 71 bpm Height:168cm weight:59kg BMI: 20.9

Physical Exam

Skin Dirty skin No rashes, hemorrhages, scars Moist CRT 1-2 seconds

Physical Exam

Headno lesions

Eyesanicteric sclerae, slightly pale palpebral conjunctivapupils 2-3mm

Earsno discharge, tenderness

Noseseptum midline, moist mucosa

Throatmouth and tongue moistno TPC

Physical Exam

Neck no cervical lymphadonapathysupple

Chestadynamic precordiumno heaves, thrills, or lifts, PMI at 5th ICS MCLregular rate, normal rhythmno murmurs

Lungssymmetrical chest expansion, no retractionsclear breath sounds

Physical Exam

Abdomenflat, no scars, no lesionsnormoactive bowel soundstympanitic on all quadrantsSoft nontender no masses, no organomegally

Physical Exam

Right upper extremityShoulder and Elbow

no deformity, no asymmetricalno discoloration, no lesionsno tenderness, no swellingno limitation of movementfull ROM

Physical Exam

Right upper extremityposteriorly deformed distal forearm bluish discoloration on the anterior wristno lesions

tenderness around the wristSoft tissue swelling of the anterior wristwrist ROM limitation due to painintact radial, median, and ulnar nerves (motor and sensory)allen’s sign?

ROM limitation due to pain

Salient Features

History 14 year old male R-handed 8 days PTA

Fall from 20ft on sand Right arm extended (+) R wrist deformity▪ (–) break in skin▪ (–) bruising

(–) R hand numbness Immobilized with short

posterior arm splint

Physical Exam Right upper

extremity posteriorly

deformed distal forearm

bluish discoloration on the anterior wrist

(–) external lesions noted

Pre-Operative Diagnosis

Fracture, closed, complete, transverse, displaced, distal radius, Right

Procedure Done

Closed reduction, percutaneous pinning, application of long arm cast, Right

Post-Operative diagnosis

Fracture, closed, complete, transverse, displaced, ulnar styloid, Right

Distal radius and ulna styloid fracture, Right