A 10-year-old girl presents to the urgent care with pain in her left wrist. She says she fell a day ago on her outstretched hands when she tripped on the steps of her school bus. Her mother reports that they iced the wrist and wrapped it with a flexible elastic bandage after the fall happened, but when she was typing her book report today, the wrist was bothering her even more. Physical examination revealed bony tenderness over the distal radius with mild swelling but preserved range of motion.
What is the best next step in managing this patient?
- Splint her wrist and immediately refer her to an orthopedic specialist.
- Attempt a reduction using the hyperpronation technique.
- Since this is obviously a fracture, obtain x-rays with 3 views before referring her to the ED.
- Provide pain control, immobilize her wrist in a splint, and recommend activity modification for 3 to 4 weeks.
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Answer: d. Provide pain control, immobilize her wrist in a splint, and recommend activity modification for 3 to 4 weeks.
Given the clinical findings, a torus (buckle) fracture was suspected. The patient received a dose of ibuprofen (10 mg/kg) in the urgent care for pain control. Her wrist was immobilized in a preformed splint, and she was advised to limit activity with the wrist for 3 to 4 weeks. The patient was discharged home with instructions for continued analgesia and told to follow up with her primary care provider or an orthopedic specialist if symptoms persisted.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
