Picture quiz: A teenage problem
A left handed 17 year old presented to the emergency department after falling on to the dorsal aspect of both hands. He was complaining of pain and loss of function in both hands. He was not taking any drugs and had no relevant past medical or family history.
On examination he had swelling over the dorsal aspects of both wrists and a limited range of movement within wrists and fingers due to pain (fig 1). He was tender over the ulna and radial styloid processes on palpation but had normal sensation and capillary refill in all digits.
Direct trauma is the usual cause of fracture in children, but the history is often absent. A child with a fracture is likely to be in pain and withdrawn; the child is also likely to be reluctant to use the affected limb. Swelling and deformity may be minimal; a high index of suspicion