Differential Diagnosis for 11-year-old Boy with R Wrist Pain
Single Most Likely Diagnosis
- Scaphoid Fracture: This is the most likely diagnosis given the mechanism of injury, which involves a fall onto an outstretched hand in radial deviation, a classic scenario for scaphoid fractures. The scaphoid bone is particularly vulnerable in such incidents due to its position and role in wrist movement.
Other Likely Diagnoses
- Colles' Fracture: Although less likely than a scaphoid fracture given the specific mechanism mentioned (radial deviation), a Colles' fracture (distal radius fracture) is still a possibility, especially if the fall resulted in significant impact on the wrist.
- Wrist Sprain: A sprain could occur from the fall, especially if the wrist was twisted or bent in an unnatural position during the impact.
- Radial Head or Neck Fracture: Given the radial deviation position during the fall, there's a possibility of fracture to the radial head or neck, though this is less common in the context provided.
Do Not Miss Diagnoses
- Compartment Syndrome: Although not immediately apparent, compartment syndrome is a serious condition that can arise from increased pressure within the compartments of the forearm or hand, potentially leading to nerve and muscle damage. It's crucial to monitor for signs such as severe pain, pallor, poikilothermia, paresthesia, and pulselessness.
- Vascular Injury: Damage to the radial or ulnar arteries could occur, leading to compromised blood flow to the hand. This would be an emergency requiring prompt intervention.
Rare Diagnoses
- Galeazzi Fracture: A fracture of the radius with dislocation of the distal radioulnar joint, which is less common but could be considered with an appropriate mechanism of injury.
- Monteggia Fracture: A fracture of the ulna with dislocation of the proximal radioulnar joint, which is rare in this context but should be considered in the differential diagnosis of forearm injuries.
- Scapholunate Ligament Injury: While more common in adults, significant trauma could potentially lead to ligamentous injuries in the wrist, including the scapholunate ligament.