Approach to the Critical Patient

Immediate priorities

Limb-threatening emergencies

Key decision points

Severity stratification

Median nerve assessment

Monitoring and escalation

Post-reduction monitoring

History

Mechanism and onset

Injury mechanism

Symptom characterization

Pain profile

Risk factors and context

Osteoporosis risk factors

Fall risk context

Past medical history

Prior fractures and bone health

Physical Exam

Inspection and palpation

Classic deformity assessment

Tenderness localization

Neurovascular exam

Median nerve assessment

Vascular assessment

Compartment and range assessment

Compartment syndrome screen

Associated injury screen

Differential Diagnosis

Distal radius fracture variants

Smith fracture (reverse Colles)

Barton fracture

Chauffeur (Hutchinson) fracture

Carpal and ligamentous injuries

Scaphoid fracture

Perilunate or lunate dislocation

Scapholunate ligament tear

Other mimics

Galeazzi fracture-dislocation

Wrist sprain without fracture

Laboratory Tests

Routine labs

Labs generally not required for isolated Colles' fracture

Labs for surgical candidates

Pre-operative baseline if surgery anticipated

Osteoporosis evaluation labs

Outpatient metabolic bone workup in fragility fracture

Diagnostic Tests

Scoring Systems

Fracture instability assessment thresholds (AAOS/ASSH guideline)

Frykman classification

AO/OTA classification

FRAX fracture risk score

MRI

MRI wrist indications in Colles fracture context

MRI limitations in acute setting

CT

CT wrist indications

CT performance characteristics

Ultrasound

Point-of-care ultrasound (POCUS) applications

Ultrasound for vascular assessment

Plain radiograph as primary imaging

Disposition

Discharge criteria

Criteria for safe discharge from ED

Admission and operative indications

Indications for hospital admission

Orthopedic consultation triggers in ED

Follow-up planning

Outpatient orthopedic follow-up

Osteoporosis referral

Treatment

Analgesia

First-line oral analgesia

Topical and non-pharmacologic analgesia

Procedural analgesia for reduction

Hematoma block technique

Procedural sedation

Ultrasound-guided nerve block

Closed reduction technique

Reduction maneuver steps

Acceptable post-reduction alignment

Immobilization

Splinting technique

Splint to cast transition

Surgical management

Indications for operative fixation

Surgical fixation options

Geriatric surgical considerations

Post-fracture bone health

Osteoporosis pharmacotherapy indications

Special Populations

Pregnancy

Pregnancy-specific considerations

Analgesia in pregnancy

Procedural analgesia for reduction

Geriatric

Age-related fracture pattern differences

Conservative management preference in elderly

Medication safety in geriatric patients

Frailty and functional assessment

Pediatrics

Pediatric distal radius fracture differences

Analgesia in children

Reduction and immobilization in children

Child protection consideration

Background

Epidemiology

Incidence and prevalence

Sentinel event significance

Complications epidemiology

Pathophysiology

Fracture mechanism

Osteoporotic bone failure pattern

Median nerve injury mechanism

Therapeutic Considerations

Evidence base for treatment selection

Immobilization duration evidence

Osteoporosis secondary prevention

Patient Discharge Instructions

copy discharge instructions

Wrist fracture home care

Finger and hand exercises

Return to emergency department immediately for

Follow-up appointments

Bone health

References

Guidelines and key sources

AAOS and ASSH clinical practice guidelines

Key randomized controlled trials

Cochrane systematic reviews

Osteoporosis and bone health guidelines

Analgesia guidelines

ICD-10 coding references