David Nelson , MD
Private Practice, San Francisco
Webmaster, eRadius
Associate Editor, J Hand Surgery
Director, San Francisco Bay Area Hand Club

(case submitted March 13, 2006)

The patient is a 51 YO female legal assistant.  She stated that she fell while sailing, suffering a distal radius fracture.  Her past medical history shows that she is a chronic alcoholic, is bipolar, and takes Effexor (for major depressive disorder) and Risperdal (for schizophrenia).  She fell on September 11 but did not think anything serious was wrong, and presented to the ER on September 25. The following xrays were taken:

These are the xrays (PA, oblique, lateral) obtained on presentation to the ER

The ER physician diagnosed a minimally displaced distal radius fracture. The patient was splinted and referred to me. The patient was seen in the office two days later. She stated that she was injured on September 18, and seen in the ER September 19 (note these dates are incorrect). She claimed to have been clean and sober for almost a year. She was observed washing her hands in the office, and there was no evidence of pain. However, she was complaining of a lot of pain and requested opioid pain medication. The majority of the visit was spent discussing pain medication. The following films were obtained:

These are the xrays (PA, oblique, lateral) obtained on presentation to the office


(1) What would your recommendation be?


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