BODYCAST - THE OFFICIAL JOURNAL OF THE CSOT

A fall from Frye's Leap:
Multiple hand injuries pose treatment challenges

By David J. Gallant, RN, OTC

Reprinted with permission from The Journal, A publication of the National Association of Orthopaedic Technologists, Volume 9, Issue 2.

It was a hot summer afternoon on Sebago Lake in southern Maine, a great day for boating, water skiing, and jumping off high ground into cool, refreshing water. Frye's Leap is a locally known, granite escarpment towering 30 metres above the shore with a knife edge plummeting 90 metres below the surface.

Harboring a spectacular view, Frye's Leap is a dangerous place that is guarded during the day to keep would-be "leapers" off the private property. It is somewhat a right of passage for those who frequent Sebago Lake to at least climb part of the cliff. From the cliff, there are three levels above the water-on the right is a 3-metre ledge, the middle level is 12 metres high and the top level is approximately 20 metres high.

Those who are foolhardy generally climb to the top and make a quick running jump over the edge to clear the midlevel ledge 9 metres below. On one particular day, a man was simply tak­ing his friends to the top to show them the view.

Unfortunately, after completing the arduous climb, he slipped on gravel at the edge and fell head first toward the ledge and the water below. As he approached the ledge with increasing velocity, he was able to fend off the outcropping with his out­stretched left arm, preventing head injury. While slowed for a millisecond, his body continued its final descent into the water below.

His friends clambered down to his aid, dove into the cold water to rescue him, and then attempted to discern how to move him from the water into the boat. The anxiety of the rescue was compounded by the patient's bloody, deformed left arm.

Diagnosis and treatment approach
Finally ashore, the patient was driven to a hospital where he was examined, x-rayed, splinted, and informed that his wrist injury was beyond the emergency room staff's expertise. He was then sent to the regional medical centre. Cross-examina­tion at the second emergency room revealed abrasions to his left upper arm and palm. There was also a severe, dinner-fork deformity of the left distal radius.

Sensory exam showed normal median and radial nerve, although ulnar nerve function was impaired secondary to dis­comfort and inability to perform the specific tests for this nerve. Radial pulses were noted. Although several open abra­sions of the palm and upper arm were present, the elbow and shoulder joints were uninjured. X-rays of the forearm and wrist showed 100% dorsal dislocation of the radiocarpal joint with severe comminution of the distal radius and ulna. which required immediate reduction (replacing bone fragment, to as near anatomic position as possible).

This abstract is a portion of the article which appears in the Fall 2008 issue of BodyCast.  
[SUBSCRIBE TO CSOT JOURNAL]