FOOSH—OUCH!

A twelve-year-old boy presents with right wrist pain after a fall onto outstretched hand (FOOSH). The injury was isolated to the right wrist, which was swollen, visibly deformed, but neurovascularly intact distally. Imaging revealed a distal radial and ulna fracture with dorsal displacement. Injuries after a FOOSH include physeal fractures, incomplete fractures, supracondylar fractures, and soft-tissue injuries. Open fractures and neurovascular compromise warrant emergent orthopedic consultation. Displaced fractures should be reduced in the ED and immobilized in a sugar tong splint. Local anesthetics and procedural sedation are important tools to relieve pain and improve patient cooperation. Due to the risks of sedation, physicians should have a systemic approach to evaluate the patient and prepare the monitoring and airway equipment. There are many different medications and routes available. It is important for the physician to be aware of the side effects and discuss this with the patient and parents.