A 25 year old female presents after a motor vehicle collision.  She was the restrained driver of a car traveling 50 mph involved in a head on collision.  She is hemodynamically stable and complains of only left wrist pain.  On exam her left wrist has an obvious deformity without skin tenting or laceration.  She is neurovascularly intact.  An x-ray is shown.  What's the diagnosis?   Scroll down for answer. 

Diagnosis: Displaced radial styloid fracture (with perilunate dislocation of the left wrist) 

Radial styloid fractures (AKA "Chauffer's Fractures")

Mechanism: High energy forced dorsiflexion or direct blow to the wrist

Common associated Injuries

• Scapholunate dissociation (injury to the scapholunate interosseous ligament)
• Perilunate dislocation (dislocation of carpal bones relative to lunate with radiolunate alignment preserved)
• Lunate dislocation (dislocation of the lunate relative to the carpal bones with radiocarpal alignment preserved)
• Trans-scaphoid perilunate dislocation (perilunate dislocation with scaphoid fracture), and ulnar styloid fracture

Treatment

• Nondisplaced/minimally displaced fractures: closed reduction and splinting in the ED via short arm cast or sugar tong splint with early orthopedic follow-up
• Severely displaced fractures or those with other associated unstable injuries: often require surgical repair

Possibel long term complications

• Median nerve neuropathy
• Radial shortening

References:

Biome, Andrea L and Megan E Healy, “Wrist.” Simon’s Emergency Orthopedics, 8e. Ed Scott E Sherman. New York, NY: McGraw-Hill, 2018.

Escarza, Robert, et al. “Wrist Injuries.” Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. Eds Judith E Tintinalli, et al. New York, NY: McGraw-Hill, 2016.

Jordanov, Martin I and Robert Warne Finch.  “Chapter 9: Upper Extremity.”  The Atlas of Emergency Radiology. Eds Jake Block, et al. New York, NY: McGraw-Hill, 2013.