One of the most common fracture locations seen in EM (1/6th of all fractures)
Surgical rates are approximately 15-20%
Bimodal injury distribution:
Younger patients (10-14yo)
Usually involved in sport and usually high energy mechanism
Sport associated injury: Artificial turf increase risk by 5x.
Increased risk with skiing and rugby
Increased risk with novice and intermediate snowboarders who don’t wear protective equipment.
Older patients (>50yo)
Associated with osteoporotic bone from low energy fall
Risk factors among older patients: Hx of recurrent falls, prior fragility fracture, decreased bone density, corticosteroid use, and also dementia when patient reaches age 75.
Encourage your older patients who sustain this injury to discuss bone density testing with their PCP. Patients at higher risk of hip fractures (which carries high morbidity and mortality)
Check and document median nerve function in all patients esp. in high energy injuries
Median nerve involved in up to 21-30%.
Check “A-OK sign” against resistance
Iatrogenic median nerve injury can also occur if patient splinted in position of flexion
