Chauffeur's Fracture

Wrist Case #5

History and PhysicalCC: wrist painHPI: 45 yo right-handed male

presents to the ED s/p mechanical fall complaining of R wrist pain. Patient states that he was working in the yard, when he tripped over a shovel and landed on his outstretched R hand. He experienced immediate throbbing pain to R wrist worsened with movement. He denies other injuries. He denies weakness or sensory changes in the extremity. Pain is 7/10 on scale. Event occurred one hour prior to arrival.

VS: T: 97.9 P: 95 R: 18 BP: 156/87 Musculoskeletal: RUE: wrist is tender over distal radius. No snuffbox TTP. No pain on axial loading. No gross deformities. 2+radial pulse. 1+ulnar pulse. <2sec cap refill in all 5 digits. Normal motor,sensory function of median/radial/ulnar nerves.

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Diagnosis: Radial Styloid Fracture

AKA: Chauffeur’s Fracture

If obvious intercarpal injury, then emergent ortho consult

If no associated injuries, sugar tong splint and urgent ortho f/u

Requires Close Orthopedic evaluation because most require ORIF

ED Management

Mechanism of injury: Direct blow to distal radius or fall onto outstretched hand,

often with compression of scaphoid against styloid fragment

Chauffer’s FractureNamed because was common occurrence in chauffer’s who

experienced a backfire of the care while they were hand cranking the engines of early cars

Underlying pathology: Avulsion fracture with extrinsic ligaments remaining attached to styloid fragment

Associated injuries: often accompanied by intercarpal ligamentous injuries (scapholunate dissociation, perilunate dislocation)

Pearls

Other Images

ReferencesKoval, K. et al. Handbook of Fractures. 4th

Edition. 2010.

Northwestern University School of Medicine: Emergency Medicine Residency Orthopedic Teaching Files http://www.feinberg.northwestern.edu/emergencymed/residency/ortho-teaching/

Wheeles Ortho online textbook http://www.wheelessonline.com/

http://radiopaedia.org/articles/chauffeur-fracture