1. Arm Injury A Case Discussion

2. Case Presentation
Patient History

3. General Data TO 14 year old male Lives in Palau Right-handed
Informant: Patient, good reliability
Chief Complaint: Wrist Injury

4. History of Present Illness
Fall
2nd floor of house ~ 20ft
hitting 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

5. History of Present Illness
Consult at local hospital X-ray revealed fracture of the distal radius Given Tramadol Discharged (no ortho) (-) Change in sensorium (-) Nausea, vomiting, seizure (-) numbing of R hand
8 days PTA
Admission

6. Review of Systems General: no weight loss,
Cutaneous: no lesion, no pruritus
HEENT: with occasional headaches
no redness
no aural/nasal discharge
no neck masses
no sore throat
Cardiovascular: no easy fatigability, fainting spells, no palpitation
Respiratory: no cough, colds
Abdominal: no change in bowel movement
Genitourinary: no change in urination
Endocrine: no polyuria, polydypsia, no heat/cold intolerance
Hematopoietic: no easy bruisability, or bleeding

7. 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

8. Family History Diabetes Mellitus, Heart Disease
No hypertension, asthma, cancer, stroke, or allergies

9. 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

10. Case Presentation
Physical Exam

11. Physical Exam General Survey Vital Signs
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

12. Physical Exam Skin Dirty skin No rashes, hemorrhages, scars Moist
CRT 1-2 seconds

13. Physical Exam
Head no lesions Eyes anicteric sclerae, slightly pale palpebral conjunctiva pupils 2-3mm Ears no discharge, tenderness Nose septum midline, moist mucosa Throat mouth and tongue moist no TPC

14. Physical Exam
Neck no cervical lymphadonapathy supple Chest adynamic precordium no heaves, thrills, or lifts, PMI at 5th ICS MCL regular rate, normal rhythm no murmurs Lungs symmetrical chest expansion, no retractions clear breath sounds

15. Physical Exam
Abdomen flat, no scars, no lesions normoactive bowel sounds tympanitic on all quadrants Soft nontender no masses, no organomegally

16. Physical Exam
Right upper extremity Shoulder and Elbow no deformity, no asymmetrical no discoloration, no lesions no tenderness, no swelling no limitation of movement full ROM

17. Physical Exam
Right upper extremity posteriorly deformed distal forearm bluish discoloration on the anterior wrist no lesions tenderness around the wrist Soft tissue swelling of the anterior wrist wrist ROM limitation due to pain intact radial, median, and ulnar nerves (motor and sensory) allen’s sign? ROM limitation due to pain

18. 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

19. Pre-Operative Diagnosis
Fracture, closed, complete, transverse, displaced, distal radius, Right

20. Procedure Done
Closed reduction, percutaneous pinning, application of long arm cast, Right

21. Post-Operative diagnosis
Fracture, closed, complete, transverse, displaced, ulnar styloid, Right
Distal radius and ulna styloid fracture, Right