From the Guidelines
The patient should be placed in a splint despite the negative X-ray, as a fracture may still be present and splinting can help reduce pain and prevent further injury. When a patient has persistent pain and swelling after a fall, a fracture may still be present even with negative initial X-rays 1. A removable wrist splint should be applied for comfort and protection, typically for 7-10 days. The patient should be instructed to remove the splint several times daily for gentle range of motion exercises to prevent stiffness.
Key Considerations
- If symptoms persist beyond 10-14 days, follow-up imaging such as repeat X-rays or MRI may be warranted to evaluate for occult fractures, particularly scaphoid fractures which are notorious for being missed on initial X-rays 1.
- The approach of splinting and follow-up imaging balances the need for protection while symptoms are acute with prevention of unnecessary immobilization.
- The splint provides pain relief by limiting movement at the injured site while allowing the initial inflammatory response to subside and potential hairline fractures to begin healing.
Imaging Recommendations
- Either MRI without IV contrast or CT without IV contrast is usually appropriate for evaluating suspected radiographically occult fractures or stress fractures 1.
- MRI is highly sensitive to changes in bone marrow composition and can be used to identify radiographically occult acute fractures throughout the skeleton, including in the wrist 1.
From the Research
Wrist Injury and Potential Fracture
- The patient has experienced a fall and is now showing symptoms of pain and swelling in the wrist, despite an X-ray showing no signs of a fracture.
- It is essential to consider the possibility of a fracture, even with a negative X-ray result, as some fractures may not be immediately visible on radiographs 2.
Use of Splints for Immobilization
- Immobilization using a splint can be beneficial in reducing pain and promoting healing in patients with potential fractures 3.
- The use of a splint, such as the Andante® splint, has been shown to significantly reduce subjective pain perception in patients with lower extremity fractures 3.
Pain Management and Fracture Healing
- Ibuprofen has been found to be an effective analgesic for patients with fractures, and its use does not appear to delay bone healing 4.
- In fact, a study on Colles' fractures found that ibuprofen had no significant effects on radiological, functional, densitometrical, or biochemical outcomes, and it provided effective pain relief 4.
Considerations for Patient Care
- It is crucial to carefully evaluate the patient's condition and consider the potential benefits and risks of immobilization and pain management strategies.
- The patient's symptoms and medical history should be taken into account when determining the best course of treatment, and further imaging or consultation with a specialist may be necessary to confirm the diagnosis and develop an effective treatment plan.