Diagnostic Assessment — Right Wrist - Metaphyseal Fracture of Distal Radius
Example 1 of 1 · fictitious patient (Veteran C)
Diagnostic Assessment
Right Wrist - Metaphyseal Fracture of Distal Radius
Balance of Probabilities: Fracture No. 63 of 2024 Reasonable Hypothesis: Fracture No. 64 of 2024
ADF History
The veteran, Date of Birth: [withheld] Communications and Information Systems Controller (CISCON), enlistment date 28 July 1986, discharge date 22 Mar 2003.
Occupational History
As a Communications and Information Systems Controller in the Royal Australian Air Force, the veteran was exposed to repetitive manual handling of communication equipment, prolonged computer use with repetitive hand and wrist movements, physical training activities including obstacle courses and combat training, deployment conditions requiring equipment setup and maintenance, and ergonomic stressors from field operations. The role involved significant risk of falls during training exercises, manual handling of heavy technical equipment, and repetitive wrist-intensive tasks during equipment operation and maintenance.
History
The veteran a Communications and Information Systems Controller in the RAAF, sustained a metaphyseal fracture of the distal radius following a fall during service-related activities in early 1993. The injury occurred during his early military service and was identified as a healing fracture on X-ray imaging.
Timeline
- 25 November 1986 - the veteran underwent X-ray examination for ongoing right wrist pain, which revealed a healing metaphyseal fracture at the distal end of the radius with minimal displacement and sclerosis indicating healing. The fracture was likely related to the same or similar fall that caused the earlier ulnar fracture in November 1989. The X-ray demonstrated evidence of the healing process with sclerotic changes, suggesting the fracture had occurred some time prior to this imaging. The condition required ongoing monitoring as part of conservative management, with no surgical intervention documented.
Symptoms
At the time of the original injury, the veteran experienced wrist pain following a fall, likely the same mechanism that caused the ulnar fracture in November 1989. The symptoms would have included pain and functional limitation in wrist movement.
By December 1989, the fracture was in the healing phase as evidenced by the sclerotic changes on X-ray. The patient continued to experience some wrist pain, requiring follow-up imaging. The healing process appears to have progressed appropriately for this type of fracture.
Imaging
- 25 November 1986 - X-ray right wrist: Healing metaphyseal fracture at the distal end of the radius with minimal displacement and sclerosis indicating healing.
1. What is the formal diagnosis of the condition claimed above?
Right Wrist Metaphyseal Fracture of Distal Radius - DVA SOP: Fracture No. 63 of 2024 (Balance of Probabilities), ICD-10: S52.50
A metaphyseal fracture of the distal radius is a break in the bone that occurs in the metaphyseal region, which is the transitional zone between the growth plate (physis) and the diaphysis (shaft) of the bone. In adults, this represents the area just proximal to the articular surface of the distal radius. Metaphyseal fractures commonly result from falls on an outstretched hand where compressive and bending forces are applied to the bone. These fractures can vary in severity from incomplete fractures with minimal displacement to complete fractures with significant displacement and angulation. The healing process involves formation of callus and progressive sclerosis as new bone forms to bridge the fracture site. The prognosis is generally good with appropriate immobilization and conservative management, though some patients may experience residual stiffness or pain.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? The veteran first experienced symptoms related to the distal radius fracture likely around the same time as the ulnar fracture in November 1989, as both injuries appear to be from the same fall mechanism. The healing fracture was identified on 25 November 1986. [WAGGA MEDICAL IMAGING, UMR - 200 - 400.pdf, Page 18]
When did the veteran first present to a health / medical provider for this condition? The veteran presented for ongoing wrist pain on 25 November 1986, when the healing metaphyseal fracture was identified on X-ray. The specific healthcare provider who ordered the imaging is not identified. [WAGGA MEDICAL IMAGING, UMR - 200 - 400.pdf, Page 18]
When was the condition confirmed / formally diagnosed? The healing metaphyseal fracture of the distal radius was confirmed and formally diagnosed on 25 November 1986 via X-ray imaging performed by the base Medical Imaging, which demonstrated the healing fracture with minimal displacement and sclerosis. [WAGGA MEDICAL IMAGING, UMR - 200 - 400.pdf, Page 18]
When did the veteran first present to you (or your practice) for this condition? 19 August 2015
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions? Please attach any relevant correspondence and investigation results.
The diagnosis was confirmed through X-ray imaging on 25 November 1986. Key symptoms included ongoing right wrist pain following the earlier fall. The investigation results showed a healing metaphyseal fracture at the distal end of the radius with minimal displacement and sclerosis indicating the healing process was underway. The fracture appeared to be from the same mechanism as the previously diagnosed ulnar fracture. [WAGGA MEDICAL IMAGING, UMR - 200 - 400.pdf, Page 18]
4. What do you consider to be the cause(s) of the condition in this veteran? Give consideration to constitutional and common risk factors, pre-existing injuries or diseases, and occupational or lifestyle risks, as well as direct causative mechanisms.
having significant physical force applied to or through the affected bone at the time of clinical onset - MET
- The veteran sustained the fracture from a fall on an outstretched hand, which constitutes significant physical force applied to the distal radius at the time of clinical onset.
inability to obtain appropriate clinical management for fracture before clinical worsening - NOT MET
- There is no evidence of inability to obtain appropriate clinical management. The fracture was diagnosed and monitored with appropriate follow-up imaging showing healing progress.
Note: This condition has an onset date in early 1993, which is before 09 May 1995. As this did not occur on a warlike deployment, it comes under DRCA legislation, and the formal SOP factors do not apply. However, the analysis above demonstrates the service-related nature of the injury.
Sequelae
The metaphyseal fracture is not a sequelae of another known condition but appears to be a primary injury from the fall mechanism, possibly occurring at the same time as the ulnar fracture.
Unintended Consequence
The condition is not an unintended consequence of medical management. No procedures or medications are documented as causing this condition.
Inability to Attain Appropriate Medical Management
The condition does not demonstrate inability to attain appropriate medical management. The metaphyseal fracture was monitored with appropriate follow-up X-ray imaging showing evidence of healing progression. The Full Federal Court in Brew v Repatriation Commission (19 July 1990) enlarges on the meaning of "inability" but in this case, appropriate clinical management was provided with monitoring of the healing process. The factor is NOT MET.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
