Wrist Injury In A Basketball Player With Unexpected Findings

Title: Wrist Injury in a Basketball Player with Unexpected FindingsAuthors: Joseph Giannetta, M.D., Stanley Hunter, M.D., Max Kammerman, M.D. Institution: United Health Services, Vestal New York HPI: 12-year-old male was playing basketball with his friends when the opponent grabbed the ball from his hand forcing his wrist into hyperextension. The patient was taken to the walk-in clinic by his parents where imaging was obtained. The patient’s wrist was splinted and covered in an ACE wrap, with directions to take ibuprofen as needed for pain. He was instructed to follow up with orthopedics in two days. PHYSICAL EXAM: On exam, swelling was noted at the distal forearm. Tenderness was noted at the distal radius and TFCC. No tenderness noted at the distal ulna, carpals, metacarpals, snuffbox, or scaphoid tubercle. Sensation and strength were intact, and radial pulses were palpable. DIFFERENTIAL DIAGNOSIS: 1.Buckle fracture of the distal radius2.Distal ulnar styloid avulsion fracture3.Scapholunate ligament sprain4.TFCC injury5.Carpal synostosis FINAL/WORKING DIAGNOSIS: Buckle fracture of the distal radius with lunotriquetral coalition TESTS AND RESULTS: Initial x-rays demonstrated a buckle fracture of the distal radial metaphysis of the left wrist with mild angulation. There also appeared to be a fusion between the lunate and triquetrum. TREATMENT AND OUTCOMES: The patient was put in a short arm waterproof cast for 6 weeks. The patient and family were also counseled about lunotriquetral coalition and how this is a normal congenital variant. He was seen back in the clinic 6 weeks later for cast removal and repeat x-rays. X-rays demonstrated sclerosis at the distal radial shaft indicating healing of the buckle fracture. Physical exam revealed normal strength and ROM with no tenderness to palpation at the distal radius. There was some mild tenderness at the TFCC which may be due to lunotriquetral coalition that was seen on imaging.