Radiology Review

Birthdays, Booze, and … Broken Bones?

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Birthdays, Booze, and … Broken Bones image

A 60-year-old man is brought to your facility emergently for decreased consciousness secondary to alcohol intoxication. He is somewhat incoherent, but from what you gather, he was attending a birthday celebration. He does not know how much he drank.

The patient complains of a headache and pain in his left wrist. You ask if he fell or was assaulted, but he does not respond. His medical history is otherwise unknown.

His initial vital signs are stable, and primary survey does not show any major injuries. He appears to spontaneously move all four extremities.

Closer examination of his left wrist shows no deformity or swelling, but the dorsolateral aspect of his hand is tender. Radiograph of his left wrist is obtained (shown). What is your impression?


 

Birthdays, Booze, and … Broken Bones image

ANSWER

The radiograph shows two fractures: one within the distal ulna and one within the fifth metacarpal. On closer examination, you can see that a bony callous surrounds each of the fracture lines, making these injuries more likely to be subacute or remote than acute.

Review of the patient's electronic health record showed he had presented three months earlier for a left hand and wrist injury, at which time an acute fracture was diagnosed. Nonetheless, he was placed in a splint and referred to orthopedics for outpatient follow-up.

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