A 41-Year-Old with Dorsal Wrist Pain After a Slip-and-Fall

Differential Diagnosis

• Avulsion fracture, dorsal wrist
• Wrist sprain
• Ulnar styloid fracture
• Scaphoid fracture

Diagnosis

This patient was diagnosed with an avulsion fracture of the dorsal wrist (typical location is a dorsal avulsion fracture of the triquetrum). The triquetrum may be fractured by means of impingement from the ulnar styloid, shear forces, or avulsion from strong ligamentous attachments. It is the second most common carpal bone fracture, after the scaphoid.

Learnings/What to Look for

• There are three fracture patterns often observed: dorsal avulsion fractures (93% of fractures), body fractures, and palmar avulsion fractures
• The findings on lateral view are called “the pooping duck” sign

Pearls for Urgent Care Management

• Treatment may be nonoperative or operative
  • Indications for nonoperative treatment (immobilization for 4 to 6 weeks) include dorsal cortical fractures without evidence of instability, nondisplaced body fractures, and palmar cortical fractures without evidence of instability
  • Indications for operative treatment (open reduction and internal fixation) include dorsal cortical fractures with evidence of instability, displaced body fractures, and palmar cortical fractures with evidence of instability

Acknowledgment: Images and case provided by Experity Teleradiology (www.experityhealth.com/teleradiology).