Teaching Case

Fall on out-streched left hand while playing rugby.Dorsal radiocarpal dislocation was diagnosed by plain radiographs and reduced under local anaesthesia .

46 years old patient was tackled while playing rugby and fell awkwardly on out-streched left hand. On examination the wrist was grossly swollen with obvious deformity and wrist held in extension.There was no skin tenting or neurovascular deficit .Distal circulation was intact. Radiographs of left wrist showed dorsal dislocation of the carpus and undisplaced fracture of radial styloid.No osteochondral fragments were seen. Closed reduction of the fracture was carried out under local anaesthesia with difficulty and below elbow back slab was applied. Post reduction check radiographs showed satisfactory position of radiocarpal joint. The fracture was treated in a below elbow scotch cast for six weeks followed by intensive physiotherapy and the out come was uneventful.

A stress fracture is a partial or complete bone fracture that results from repeated application of stress lower than the stress required to fracture the bone in a single loading. Prevention or early intervention is the preferable treatment. However, it is difficult to predict injury because runners vary with regard to biomechanical predisposition, training methods, and other factors such as diet, muscle strength, and flexibility ⁽¹⁾. Stress fractures account for 0.7% to 20% of all sports medicine clinic injuries. Stress fracture of calcaneus is rarer than other stress fractures of the foot. The majority of stress injuries of the calcaneus occur in the posterior part of the bone, but a considerable proportion can also be found in the middle and anterior parts. To obtain a diagnosis, magnetic resonance imaging is warranted if plain radiography does not show abnormalities in a physically active patient with exercise-induced pain in the ankle or heel ⁽²⁾. Calcaneal stress fractures can occur in any population of adults and even children and are common among active people, such as athletes, sports enthusiasts, and military personnel. It is likely that the number of diagnosed Calcaneal stress fractures will rise among practitioners with an increased recognition of their possibility ⁽³⁾. Treatment includes reduction of activity, cast or brace immobilization until symptoms resolve and bone healing is evident on radiographs. Most physician allow 4-8 weeks prior to resumption of activity ⁽⁴⁾.