Differential Diagnosis for a 9-year-old with a Volar Aspect of the Pisiform Fracture
- Single most likely diagnosis:
- Fracture of the forearm (specifically, a fracture involving the pisiform bone or the surrounding area): This is the most likely diagnosis given the patient's history of a fall onto her left forearm and the reported pain from the wrist to the elbow. The mechanism of injury and the location of the pain are consistent with a fracture.
- Other Likely diagnoses:
- Sprain or strain of the forearm or wrist: Although the patient reports a fracture, it's possible that the injury could be a severe sprain or strain, especially if the pain is not localized to a specific area.
- Contusion of the forearm or wrist: A contusion could also be a possibility, given the mechanism of injury and the reported pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Compartment syndrome: Although less likely, compartment syndrome is a serious condition that can occur after a fracture or severe injury to the forearm. It's essential to monitor for signs of compartment syndrome, such as increasing pain, pallor, paresthesia, poikilothermia, and pulselessness.
- Vascular injury: A vascular injury, such as a brachial artery injury, could occur with a forearm fracture and is a potentially life-threatening condition.
- Rare diagnoses:
- Osteochondritis dissecans: This is a rare condition where a piece of cartilage and bone becomes detached from the surrounding bone, which could potentially occur in the forearm or wrist.
- Pathological fracture: Although rare, a pathological fracture could occur if the patient has an underlying bone condition, such as osteogenesis imperfecta or a bone cyst.