A patient presented with a history of fall on outstretched hand. There is pain & swelling over the radial aspect of the wrist without any obvious deformity. Radial styloid process is at a lower level than the ulnar styloid process. Tenderness can be elicited in anatomical snuff box. Findings are consistent with the diagnosis of: March 2013 (e)
## **Core Concept**
The question describes a clinical scenario suggestive of a wrist injury, specifically a fracture occurring due to a fall on an outstretched hand. The symptoms and signs point towards a common type of wrist fracture. The **radial styloid process** and **ulnar styloid process** are anatomical landmarks on the wrist, and their alignment can be altered in certain fractures.
## **Why the Correct Answer is Right**
The description provided—pain and swelling over the radial aspect of the wrist, tenderness in the anatomical snuff box, and the radial styloid process appearing lower than the ulnar styloid process—strongly suggests a **scaphoid fracture**. The scaphoid bone is crucial for wrist motion and is commonly fractured when individuals fall on an outstretched hand. The anatomical snuff box, where tenderness is elicited, is the area on the radial side of the wrist where the scaphoid bone can be palpated. The scaphoid fracture can lead to a change in the wrist's anatomy, making the radial styloid process seem lower due to the bone's proximal pole fracture and subsequent displacement.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is not provided, but typically, other types of wrist fractures or injuries (like a **lunate fracture** or **triquetrum fracture**) do not present with tenderness specifically in the anatomical snuff box or alter the styloid processes' alignment in the same way.
- **Option B:** Similarly, without the specific option provided, other wrist injuries like **distal radius fractures** usually present with more obvious deformity (like a "dinner fork" deformity) and might not specifically cause tenderness in the anatomical snuff box.
- **Option D:** Again, without specifics, other fractures or injuries around the wrist might not precisely match the combination of symptoms and signs described.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that **scaphoid fractures** are notorious for potentially poor healing due to their precarious blood supply, which enters the bone distally. Therefore, these fractures require prompt immobilization and follow-up. A useful mnemonic is to suspect a scaphoid fracture in any patient with wrist pain after a fall on an outstretched hand, especially if there's tenderness in the anatomical snuff box.
## **Correct Answer:** C. Scaphoid fracture.