Journey of a Broken Wrist

1
The Worst Day Skiing

Broken wrist
Broken wrist from a skiing accident. (c) Tara Fontana

There is an old saying: The worst day skiing (or fishing, golfing, camping, etc.) is better than the best day working. In one case, Victoria Fontana might disagree with that statement.

On a ski trip with friends, Tori took a tumble and ended up hurting her wrist. It was in a lot of pain and she sought help. The ski patrol called an ambulance for her and she was transported to the hospital. Her family was not with her at the time and Tori isn't yet 18. As you'll see, the fact that Tori was underage and didn't have an adult with her played an important part in her care--or lack of it.

Above is a picture of her wrist as it appeared when she arrived at the emergency department. Look closely and you can see the remnants of a splint placed in the field, probably by the Ski Patrol.

It's a pretty typical Colles fracture, also known as a dinner fork fracture because of its classic shape. Notice the deformity and discoloration (bruising). These types of fractures are very common when we put our hands down to break a fall.

The next page shows an x-ray of Tori's wrist and better explains what happens in a Colles fracture.

2
X-ray of a Colles Fracture

xray of broken wrist
Xray of broken wrist (fracture circled in yellow). Image provided by Tara Fontana

The previous page shows how this fracture looked with the naked eye. It's commonly called a dinner fork fracture because of the shape of the wrist when it happens.

The broken bone is pretty obvious in the x-ray. The bone that is fractured is called the radius. It is the bigger of the two bones in the forearm and attaches to the wrist on the same side as the thumb.

Sometimes it takes a trained eye to identify a fracture on an x-ray. There are hairline breaks that can be difficult to see unless you know the anatomy inside and out and have spent years looking at images like this one.

Then there are fractures like Tori's. Almost anyone would recognize the jagged edges of a broken bone in this picture. Indeed, it makes me cringe every time I see it.

That's gotta hurt, I tell myself. And Tori says it did hurt. In fact, it was excruciating, but as I said at the beginning, she wasn't yet 18.

Tori couldn't sign for herself. She couldn't technically make medical decisions as an adult. In medical legal terms, she couldn't give informed consent. That doesn't mean she doesn't get treatment. If her injury was life threatening, for example, caregivers would be remiss not to begin treatment. In that case, they could provide treatment based on what is known as implied consent, meaning that it is implied that if the parents were there, they would give permission to save their daughter's life.

Tori is a teenager, on the other hand, so maybe we shouldn't assume they'd choose life.

Anyway, because mom and dad aren't readily available, the emergency department staff decides to only provide whatever care was necessary to avoid long-term damage to Tori's arm (or to save her life if necessary, but this injury wasn't bad enough to kill her, making that a moot point).

The care Tori received was the bare minimum. See what Tori got for treatment on the next page.
 

3
Reduction of a Colles Fracture

Traction on broken wrist
Vyctoria gets traction to treat her broken wrist. (c) Tara Fontana

When Tori Fontana broke her wrist on a ski trip, she ended up at the hospital with no family around. Unfortunately, Tori wasn't 18 and therefore couldn't consent to her own treatment.

On the previous page, Tori's x-ray revealed a distal fracture of her left radius. Known as a Colles fracture, this break is commonly referred to as the dinner fork fracture because of its classic shape.

Since her broken wrist wasn't life threatening and because her parents weren't there, Tori's caregivers opted to only treat her fracture as necessary to prevent long-term damage. It's called implied consent, which basically means the caregivers could assume that if Tori's parents were present, they would authorize this level of treatment.

Unfortunately for Tori, her caregivers didn't include pain control in their assumption of implied consent. Because of that, she didn't get any pain medications during her treatment, at least not until mom showed up.

To reduce her Colles fracture, Tori's left arm was placed in traction using a combination of finger traps and weighted belts. They had to give her muscle relaxants to prepare her arm, but since they didn't provide pain medication, she said the pain was excruciating.

Ultimately, closed reduction of Tori's broken wrist wasn't successful. She ended up returning to see a surgeon a couple of weeks later. The next page shows how Tori's arm looked after surgery.

4
Surgical Repair of a Colles Fracture

xray of surgically repaired fracture
Xray of Vyctoria's broken wrist shows the plate and screws used to repair it. Image provided by Tara Fontana

After a skiing accident broke her wrist, Vyctoria (Tori) Fontana had the fracture reduced through traction and put in a cast in the emergency department. Unfortunately since her parents weren't there, it was all done without pain medication.

When the fracture didn't heal correctly, Tori's regular doctors brought her back to the hospital (a different hospital) for surgery. In order to put all the bones back together properly, they screwed plates into the bones of her forearm to hold them in place as they heal. The surgery was successful and now Tori has metal plates in her arm.

As Tori's wrist continues to heal, she will no doubt have noticeable issues with range of motion. Of course, it will be nothing compared to the potential loss of function she could've had if the fracture didn't heal correctly in the first place.

Colles fractures are some of the most common types of broken bones seen in the ER. In Tori's case, not having a parent present to authorize the use of pain medication was the biggest drawback to her treatment.

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