Wrist Injury: What's Your Impression?

February 20, 2014
Brady Pregerson, MD

Test your radiographic skills with this emergency medicine case. Can you spot the injury? Is there more here than initially meets the eye?

A 52-year-old man presents to the emergency department with a left wrist injury after a ground level fall. He states that he felt fine prior to slipping on a wet floor in his kitchen. There was no loss of consciousness, weakness, dizziness, chest pain, or preceding illness and he denies palpitations. He states that he did not hit his head and reports no neck or back pain or other injuries. He has no other complaints. There is no significant past medical history and there are no known risk factors for osteoporosis although he does smoke cigarettes.

On physical examination, the patient’s vital signs are normal and he appears to be in mild to moderate distress. Examination of the head, neck, back, and torso are all unremarkable. Examination of the extremities shows swelling and tenderness diffusely about the left wrist with intact pulses and sensation, intact skin, and no tense compartments. The elbow and hand are not tender.

His wrist x-ray is shown in Figure 1.

What injury or injuries can you identify?

 

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