Musculoskeletal case studies for medical students

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History A 14 year old boy fell off his bicycle. Neurovascular intact, no other injuries
Initial X ray
Description AP X ray
X ray
Description Lateral X ray
Problem The 14 year old boy with wrist swelling after a bicycle accident. What is the diagnosis, how would you manage him, and what would you tell the parents regarding the prognosis?
X ray after treatment
Description AP X ray after reduction
Post management further view
Description Lateral after reduction
Classification There is a growth plate injury with dorsal displacement. No metaphyseal fragments are evident, nor is there any extension into the epiphyseal fragment. The fracture can be classified as a Salter Harris Type 1 injury.
Discussion of management

It needs to be reduced and the reduction maintained with either a plaster or smooth K-wires. There is a small possibility of angualtory or other growth deformity. The parents must be warned of this and the patient followed up until skeletal maturity to observe any growth disturbances.

This patient was given a general anaesthetic and a closed reduction was done. The surgeon opted for percutaneous K wire fixation to ensure the reduction dis not slip. Smooth stainless steel wires over the growth plate are innocuous, bur avoid any type of screw or plate fixation that crosses the growth plate. Do not perform internal fixation unnecessarily.


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