A pt cc ankle pain after being run over by a car. The foot is neurovascularly intact but there’s an obvious dislocation with skin tenting. He has no other injuries. An xray is done. How do we fix this?
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The teaching point is – for suspected carpal bone fractures, look at the lateral.
Most carpal fractures are not subtle on physical exam. The hand is swollen and tender. The common subtle fracture is the occult scaphoid fracture, which is usually tender with no swelling at all.
Many carpal fractures are subtle on x-rays. You may not see a fracture on the AP or oblique view. I always see something on the lateral, most commonly a small fragment of bone floating on the dorsal aspect (arrow).
You can easily confirm a fracture by CT imaging. CT imaging is not emergent, but we commonly get it as it helps treatment planning for the orthopedist.
