Differential Diagnosis for a 67-year-old woman with a wrist injury
- Single most likely diagnosis
- Colles' Fracture: This is the most likely diagnosis given the mechanism of injury (fall on an outstretched hand), the location of the pain and swelling (distal radius), and the specific X-ray findings (transverse fracture of the distal radius with dorsal displacement and angulation of the distal fracture fragment). The presence of a visible dorsal deformity, also known as a "dinner fork" deformity, is classic for this type of fracture.
- Other Likely diagnoses
- Smith's Fracture: Although less common than Colles' fracture, a Smith's fracture (also known as a reverse Colles' fracture) could be considered if the fracture fragment was volarly displaced instead of dorsally. However, the X-ray findings provided do not support this diagnosis.
- Distal Radius Fracture with Ulnar Styloid Fracture: This diagnosis could be considered if the X-ray had shown involvement of the ulnar styloid, but the findings specifically mention no involvement of the ulnar styloid.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Compartment Syndrome: Although the patient has intact capillary refill and normal sensation, compartment syndrome is a potential complication of fractures, especially if there is significant swelling. It's crucial to monitor for signs of compartment syndrome, such as increasing pain, pallor, poikilothermia, paresthesia, and pulselessness.
- Vascular Injury: Any fracture has the potential for associated vascular injury, which could lead to serious complications if not promptly addressed. The presence of intact capillary refill is reassuring, but ongoing monitoring is necessary.
- Rare diagnoses
- Barton's Fracture: This is a rare type of fracture that involves the distal radius with dislocation of the radiocarpal joint. It would be considered if there were findings suggestive of joint dislocation, which are not present in this case.
- Galeazzi Fracture: This fracture involves the distal third of the radius with dislocation of the distal radioulnar joint. The absence of specific findings related to the distal radioulnar joint makes this diagnosis less likely.