2. CC: wrist pain HPI: 45 yo right-handed male presents to the ED s/p mechanical fall complaining of R wrist pain. Patient states that he was working in the yard, when he tripped over a shovel and landed on his outstretched R hand. He experienced immediate throbbing pain to R wrist worsened with movement. He denies other injuries. He denies weakness or sensory changes in the extremity. Pain is 7/10 on scale. Event occurred one hour prior to arrival. VS: T: 97.9 P: 95 R: 18 BP: 156/87 Musculoskeletal: RUE: wrist is tender over distal radius. No snuffbox TTP. No pain on axial loading. No gross deformities. 2+radial pulse. 1+ulnar pulse. <2sec cap refill in all 5 digits. Normal motor,sensory function of median/radial/ulnar nerves.

4. AKA: Chauffeur’s Fracture

5. If obvious intercarpal injury, then emergent ortho consult If no associated injuries, sugar tong splint and urgent ortho f/u Requires Close Orthopedic evaluation because most require ORIF

6. Mechanism of injury: Direct blow to distal radius or fall onto outstretched hand, often with compression of scaphoid against styloid fragment Chauffer’s Fracture Named because was common occurrence in chauffer’s who experienced a backfire of the care while they were hand cranking the engines of early cars Underlying pathology: Avulsion fracture with extrinsic ligaments remaining attached to styloid fragment Associated injuries: often accompanied by intercarpal ligamentous injuries (scapholunate dissociation, perilunate dislocation)

8. Koval, K. et al. Handbook of Fractures. 4 th Edition. 2010. Northwestern University School of Medicine: Emergency Medicine Residency Orthopedic Teaching Files http://www.feinberg.northwestern.edu/emergencyme d/residency/ortho-teaching/ Wheeles Ortho online textbook http://www.wheelessonline.com/http://www.wheelessonline.com/ http://radiopaedia.org/articles/chauffeur-fracture