A 70-year-old female has fallen 2 weeks ago and developed immediate pain in her left wrist.She thought she just bruised it but is worried because it has not improved.She has used Tylenol¨ and ice at home, and that has helped slightly.You examine her and find she has moderate swelling and ecchymosis but no overtly obvious deformity.Her ROM is uncomfortable and severely diminished due to the pain.No crepitus is heard or felt.Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds.What should you do?

Question

Quizplus · Accepted Answer

The most appropriate next step would be to obtain an x-ray to rule out any bony injury or fracture. Based on the moderate swelling and ecchymosis, and severely diminished ROM, it is possible that she has a wrist fracture. Placing the wrist in a splint or prescribing a splint can help immobilize the wrist and provide pain relief until further evaluation by an orthopedic specialist. Referring her for an orthopedic evaluation without obtaining an x-ray may delay timely management. Telling her to be patient is not an appropriate management plan, and sending her to the emergency room for a non-emergent issue may not be cost-effective or necessary.

A 70-Year-Old Female Has Fallen 2 Weeks Ago and Developed