FOOSH Fracture
These 2 images are from the same patient who had a FOOSH event. This patient Fell On Out Stretched Hands. A FOOSH event commonly results a Distal radius fracture. This is also known as a Colle’s Fracture. The image also shows angulation and a small ulnar styloid fracture. Obvious Deformity was observed. When evaluating these patients always ensure Cap refill and pulses are present as well as Range of Motion. This particular patient had cool fingertips with a delayed cap refill. Then I compared the temperature and cap refill to the other hand. It was the same. Always make sure to compare both extremities when evaluating a patient. The patient did have a strong pulse, but was just cold. Range of motion was obviously decreased but the patient did very well regardless of pain.
Treatment:
Reduce the deformity and splint via a sugar tong and sent to ortho the next day. Ortho might appreciate a heads up though. If you suspect a vascular injury or compromise – immediate ortho consult is required.
You can either perform a Hematoma block for pain with oral/ IV medication or you can chose Conscious sedation. I prefer a Hematoma block as it is relatively less invasive than sedation and an easy procedure to perform. Once the patients pain is under control you can manipulate (usually with your finger on the dorsal surface of the hand where you feel the step off) the injury back in place.
Prior to reduction make sure you have a tech or someone with you who has appropriately measured the length of the patients arm and all the splint supplies ready to be applied after you have reduced the injury. You will have to hold the reduction in place until the splint has been applied appropriately.
Some providers prefer to use finger traps to help with placement of the bones post hematoma block. This is a providers preference. I personally find it helps with the reduction and sometimes the break will reduce on its own without manipulation.
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