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A snowboard edge catch, a fall on an outstretched hand, and a wrist that instantly looks wrong. We take you step-by-step through a classic distal radius fracture presentation in orthopedic urgent care, featuring a 22-year-old with dorsal displacement and the unmistakable dinner fork deformity often seen in a Colles-type fracture. If you want a practical, real-world framework for evaluating acute wrist injuries, this case is built for you. 

We start with how we describe the fracture correctly on imaging, focusing on the distal fragment, and what we look for on AP, oblique, and lateral X-rays including loss of radial height and radial inclination plus concern for intra-articular involvement near the DRUJ. From there, we shift to what can’t be missed: a careful distal neurovascular exam. With dorsal displacement, traction on volar structures can lead to neuropraxia, and we talk through why leaving a fracture unreduced can put nerves at risk. 

Then we get hands-on with the hematoma block, a useful option when IV sedation is not available. I explain why the dorsal approach is typically safer, where to place the needle relative to the dorsal step-off, how much local anesthetic we commonly use, and why timing and patience matter, especially within the first three to five days. We finish with closed reduction mechanics, the alignment numbers that guide “good enough” reduction (radial inclination, radial length, volar tilt), and how a sugar tong splint with a strong volar three-point mold helps prevent the fracture from drifting back dorsally. 

If you want to follow along visually, check out the YouTube version for the X-rays and illustrations, then subscribe, share this with someone who treats wrist injuries, and leave a review with your go-to reduction and splinting tips.

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A “simple ankle sprain” can be the most expensive diagnosis in sports medicine when it’s wrong. We’re unpacking a case that looks ordinary at first glance: a 16-year-old wrestler who can still walk, has normal-looking initial X-rays, and yet can’t return to the mat because the pain is higher than the usual sprain spot. That detail changes everything, pushing us toward a high ankle sprain and a syndesmotic injury rather than a routine lateral ligament strain. 

We talk through the exact mechanism that should set off alarms, forced external rotation often paired with dorsiflexion and sometimes eversion. From there, we map the anatomy in plain language: the lateral ligaments that drive most inversion sprains versus the anterior inferior tibiofibular ligament and the wider syndesmosis complex that stabilises the distal tibia and fibula. We also share the exam findings that matter most, including tenderness at the distal tibiofibular junction and pain reproduced with dorsiflexion plus external rotation. 

On the imaging side, we cover the practical radiology checks clinicians use every day, including tibiofibular overlap, tibiofibular clear space, and medial clear space on AP and mortise views. We explain why gravity stress views can help but also why MRI is often the decision-maker when X-rays don’t match the story. Finally, we walk through treatment and recovery: conservative care with a CAM boot and delayed weight bearing versus surgical stabilisation such as tightrope fixation for athletes chasing a faster, more reliable return to sport, plus what rehab progression typically looks like. 

If you found this helpful, subscribe, share it with a teammate or clinician, and leave a review so more athletes and providers can spot a high ankle sprain before it costs a season.

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In this episode we discuss a case presentation regarding a greater tuberosity fracture in a young patient. The X-rays and video presentation can be seen on the YouTube channel.

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