Ortho On Call Review

Consultant on call: Dr. Eleanor Vance Consultant of the week: Dr. Thomas Kelly Alice Smith 45 Female Date: 01 November 2024 Hospital Number: AS789012 Issues/Diagnosis: Right Distal Radius Fracture, Colles' type Date of injury: 30 October 2024 PMH/PSH: Hypertension (controlled with medication), no previous surgeries. DH: Lisinopril 10mg OD. NKDA (No Known Drug Allergies). SH: Lives with husband, non-smoker, occasional social alcohol, works as an administrative assistant. HPC: * Patient presented to A&E after a fall onto an outstretched right hand yesterday evening. * Experienced immediate pain and swelling in the right wrist. * Unable to move wrist since injury. * No neurovascular deficits reported by patient. * Denies loss of consciousness or head injury. On Examination: Right wrist: * Obvious deformity (dinner fork deformity) noted. * Significant swelling and tenderness over the distal radius. * Reduced range of motion due to pain. * Intact sensation to light touch in median, ulnar, and radial nerve distributions. * Capillary refill time less than 2 seconds in all digits. * Radial pulse palpable and strong. XR: AP and lateral views of the right wrist show a complete transverse fracture of the distal right radius with dorsal displacement and angulation, consistent with a Colles' fracture. No evidence of carpal bone fracture or dislocation. Ulnar styloid intact. Plan: 1. Discuss with patient about closed reduction under local anaesthetic in ED or theatre. 2. Proceed with closed reduction and casting. If reduction is unstable, consider k-wire fixation. 3. Arrange for post-reduction X-rays to confirm satisfactory alignment. 4. Refer to fracture clinic for follow-up in one week with new X-rays. 5. Provide patient with cast care instructions and pain management advice (e.g., paracetamol and ibuprofen).