The next patient we saw was a boy around 10 years old. He had no pain, but had an obvious wrist deformity - the hand was deviated very radially, to the point the ulna was sticking out visibly from the side of the wrist. The father said he had had 2 surgeries that didn't go well. I did a quick exam, noticed some strange alignment at the proximal end as well, and did range of motion testing. Actively, he had at least some movement in all directions, and passively he had full motion. It was so deformed that I wanted a second set of eyes to take a look, so I turned around to look for Dr. Henegar or Dr. Levit.
While I was turned around, Claudy (an OT/PT tech student) said, "Jeff? In the arm, there are two bones. He only has one." I looked over, Claudy is palpating down the arm, and there's a surprising lack of bone where the radius should be. I got my hands on it, and...nothing. Just an ulna. At the PRUJ, I found the radial head, but then the bone just ended. I called over the clinicians, and Dr. Levit got her hands on it. She distracted and relocated the wrist, and then was able to palpate the distal radius. A few more questions to the father, and we figured out there was some sort of sickness in his bone (infection?) before the surgeries.
Whatever happened, apparently the doctors decided to remove the shaft of the radius, but leave most of the muscle attachment sites. He had a mostly functional wrist. We will see him in clinic tomorrow afternoon, and Dr. Levit is going to attempt to fabricate a splint to hopefully help align the bones in a more permanent manner.
New item on my exam checklist: make sure the bones you assume are there, are actually there.
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