An otherwise healthy 65-year-old woman arrives at the emergency department with severe right wrist pain and visible deformity following a slip and fall onto her outstretched hand. She is alert, and her vital signs are within normal limits. Physical examination reveals a characteristic 'dinner-fork' deformity of the right wrist with moderate swelling. There are no open wounds. Radiographs demonstrate a dorsally displaced, extra-articular fracture of the distal radius. The treating physician decides to manage the fracture non-operatively. Arrange the following steps for the acute management of this patient's fracture in the correct chronological order.
- 1Perform a baseline pre-reduction neurovascular assessment of the hand and digits.
- 2Administer regional anesthesia, such as a hematoma block.
- 3Perform closed reduction using longitudinal traction and manipulation.
- 4Apply a well-molded sugar-tong splint to the affected arm.
- 5Obtain post-reduction radiographs and repeat the neurovascular assessment.
Answer
The correct sequence of management is: baseline neurovascular assessment, followed by regional anesthesia, closed reduction, splint application, and finally post-reduction radiographs with repeat neurovascular assessment.
The standard sequence for closed fracture management begins with establishing a baseline neurovascular status. Once documented, adequate anesthesia (such as a hematoma block) is provided to allow for muscle relaxation and pain control. Closed reduction is then performed to realign the bones, followed immediately by splinting (not casting, to allow for tissue swelling) to hold the reduction. Finally, post-reduction imaging and a repeat neurovascular check confirm proper alignment and ensure no iatrogenic injury occurred.
Step-by-Step Solution
Key Concept
The systematic approach to closed reduction of fractures involves pre-reduction assessment, analgesia, reduction, immobilization, and post-reduction assessment.