Differential diagnosis includes stress fracture, deep vein thrombosis, radiculopathy, tendinitis, and peripheral nerve entrapment. Definitive diagnosis involves needle measurements of compartmental pressure (Buerba et al., 2019).
Clinical Presentation Patients with chronic exertional compartment of the forearm will complain of pain localized to a compartment that typically increases with exercise. This pain gradually decreases with rest but resumes with resumption of activity (Buerba et al., 2019). Handgrip strength maybe diminished (O’Dowd et al., 2021). Distal forearm fracture Any trauma to the forearm can result in a distal forearm fracture, with many of these fractures occurring from a fall on an outstretched hand. In the elderly, isolated distal radius fractures can result from low-energy falls such as those from Colles fracture Colles fractures are common and are fractures of the distal radius with dorsal comminution, dorsal angulation, dorsal displacement, radial shortening, and an associated fracture of the ulnar styloid process. The mechanism of injury is a fall on an outstretched hand with the wrist in flexion (Summers et al., 2023). Colles fractures typically occur in young individuals (often sports-related or motor vehicle crashes) and the elderly (from falling during daily or occupational activities such as walking or cleaning their house and using protective reflexes to stop fall). The mechanism of injury for Colles fractures leads to the classic “dinner fork” deformity of the wrist with dorsal displacement of the distal radius (Summers et al., 2023). Smith fracture A Smith fracture involves fracture of the distal radius with volar displacement or angulation of the distal fragment. In addition, disruption of the distal radioulnar joint and the triangular fibrocartilage complex (TFCC) occurs. As such, it is also known as a reverse Colles fracture . The mechanism for a Smith fracture is typically either a fall onto a flexed wrist, such as falling while walking or cycling, or a direct blow to the dorsal aspect of the wrist, such as might occur on the football field (Schroeder & Varacallo, 2022). Die-punch fracture A die-punch fracture is an intraarticular fracture involving the lunate process of the radius. This fracture occurs with axial loading of the lunate, resulting in an impact fracture to the lunate process of the radius (Corsino et al., 2023). Greenstick and buckle/torus fractures Greenstick and buckle/torus fractures occur in the pediatric population and are incomplete fractures. They occur at the metaphysis of the distal radius. Torus fractures occur with axial loading, resulting in buckling of the bony cortex and periosteum without any true fracture lines (Corsino et al., 2023). There is minimal visible deformity. Greenstick fractures of the distal radius are the result of bending forces, with visible deformity bony bending present. There will be a fracture on the convex side of the bending, with an intact concave side. Scaphoid fracture Scaphoid fractures are the most common carpal bone fractures. They occur in people who are young and active. This injury is often misdiagnosed as a wrist sprain. The mechanism of injury is a fall on an outstretched hand,
a standing or seated position. In younger patients, they are typically caused by high-energy falls, such as may occur on the playground or during sports (Corsino et al., 2023).
Clinical Presentation Symptoms of Colles fractures include pain, edema, and often deformity. Palpation will likely reveal pain and tenderness. The range of motion of the wrist will be reduced. Neurovascular assessment of sensation, pulses, and motor function is indicated (Summers et al., 2023). Most Colles fractures are managed conservatively with casting.
Visualization may reveal a distal forearm deformity, and exam will usually show swelling, pain, and decreased range of motion. According to Schroeder & Varacallo (2022), up to 15% of these fractures may show symptoms of acute carpal tunnel syndrome from compression to the median nerve, so evaluation of neurovascular status is imperative. Often restoration of alignment with Smith fractures requires surgical intervention (Schroeder & Varacallo, 2022). Clinical Presentation Clinical presentation includes swelling, bruising, and deformity with observation as well as tenderness with palpation. Die-punch fractures are considered rare (Li et al., 2020). Self-Assessment Quiz Question #7 What is the name for a fracture of the distal radius with dorsal comminution, dorsal angulation, and/or dorsal displacement? a. Galeazzi fracture. b. Monteggia fracture.
c. Colles fracture. d. Smith fracture. HAND AND WRIST FRACTURES
where axial loading of the wrist into forced extension and radial deviation impacts the scaphoid on the dorsal rim of the radius, leading to fracture. Subjective history should emphasize the mechanism of injury and the position of the
EliteLearning.com/Physical-Therapy
Page 35
Powered by FlippingBook