Wrist fractures in the young and elderly

C, a 72-year-old White female, was outside walking her dog on a leash when it suddenly lunged toward a squirrel in an attempt to chase it. Mrs. C was pulled forward, tripped on the uneven sidewalk, and began to fall, her right side leaning forward. She instinctively stretched her right arm forward to break her fall and landed on the heel of her hand. She immediately felt severe pain in her right wrist and was unable to get up. A neighbor witnessed the fall and ran to assist her. The neighbor noticed that Mrs. C’s wrist looked grossly deformed and called 911. The emergency medical services (EMS) ambulance arrived several minutes later. Mrs. C was alert and oriented to person, time, and place, and her vital signs were: pulse 112 and regular, respirations 22, and BP 156/90. She complained of severe pain and a “pins and needles” sensation in her wrist. The emergency medical technicians noted that she was unable to fully move her fingers and her right radial pulse was diminished when compared to her left. She was placed in a posterior splint with a bandage wrap and transported to her local community hospital. The physical exam in the ED revealed a thin, anxious, frail, elderly woman with a “dinner fork” deformity of the right wrist. Her range of motion (ROM) of the wrist and fingers was difficult to determine due to pain. Her hand was warm and pink, and the right radial pulse amplitude equaled the left radial pulse. Mrs. C complained of numbness in her palm and middle finger. Anteroposterior (AP) radiographs revealed a distal radius fracture (see AP wrist fracture) and the lateral (L) radiographs revealed dorsal displacement of the distal fragment (see Lateral view right wrist). After the orthopedic surgeon evaluated her, Mrs. C was diagnosed with a right Colles fracture (see Colles fracture of the wrist and hand). Because her past medical history included hypertension, type 2 diabetes mellitus, and moderate chronic obstructive pulmonary disease due to long-standing asthma, the surgeon attempted a nonsurgical closed reduction of the fracture in the ED. 2.3 ANCC CONTACT HOURS