Intended for healthcare professionals

Endgames Spot Diagnosis

A painful wrist after a fall

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1642 (Published 20 April 2017) Cite this as: BMJ 2017;357:j1642
  1. Yong-Hai Zhou, consultant paediatrician1,
  2. Wei Wang, consultant paediatric orthopaedist1,
  3. Ming-Hua Zheng, consultant hepatologist2
  1. 1Department of paediatrics, Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
  2. 2Department of hepatology, Liver Research Center, First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, Zhejiang, China
  1. Correspondence to M-H Zheng, zhengmh{at}wmu.edu.cn

A 13 year old boy presented to the orthopaedic clinic for a painful wrist after a fall forward. On examination, he had a swollen painful right wrist and no limb deformities could be found. Anteroposterior and lateral radiography for the wrist was taken (fig 1). What is the diagnosis?

Fig 1
Fig 1

(a) Anteroposterior and (b) lateral radiographs of the right wrist

Answer

Wrist torus fracture.

Discussion

Radiography shows typical torus fracture changes on the right ulna and radius. Buckle of the cortex and angulation deformity can be seen on one side of the right ulna and radius. The other side of the cortex is intact (fig 2). Distinct fracture lines are not seen.

Fig 2
Fig 2

Right wrist radiographs showing local cortical folds on the right ulna (A) and radius (B), and angulation deformity on the right radius (C) and ulna (D). The other side of cortex is intact

Torus fractures usually occur at the distal radius in children, particularly after a fall. A differential diagnosis is a greenstick fracture. These fractures all usually occur in children. No distinct fracture lines could be seen in the torus fractures. The greenstick fracture is a type of incomplete fracture, with the cortex interrupted on only one side of the bone. Anteroposterior and lateral radiography enable a timely diagnosis of this condition.

Wrist torus fractures are usually treated using a cast, splint, or soft bandage for four weeks.12 In most cases surgery is not necessary and general prognosis is good.

Footnotes

  • Competing interests: All authors have read and understood BMJ policy on declaration of interests and declare the following: None.

  • Patient consent obtained.

  • Provenance: Not commissioned; externally peer reviewed.

References

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