Diagnostic Assessment — Right Wrist - Minor Torus Fracture of Distal Ulna
Example 1 of 1 · fictitious patient (Veteran C)
Diagnostic Assessment
Right Wrist - Minor Torus Fracture of Distal Ulna
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 minor torus fracture of the distal ulna following a fall on an outstretched hand during service-related activities in 1992. The injury occurred during his early military service and was diagnosed by X-ray imaging.
Timeline
- 20 October 1986 - the veteran presented with right wrist pain after a fall on an outstretched hand. X-ray examination revealed a minor torus type fracture of the distal ulnar metaphysis with no major displacement or angulation. The pain was localized to the distal ulna region, limiting wrist motion and function. The fracture was considered stable and was likely managed conservatively with splinting, as is typical for torus fractures. The presentation occurred during his early service period as a CISCON, reflecting the physical demands and training activities associated with his military role.
Symptoms
At the time of injury in November 1989, the veteran experienced immediate wrist pain localized to the distal ulna following the fall on his outstretched hand. The acute symptoms included pain and limited wrist motion and function.
The current status of this historical fracture indicates healing occurred, though the patient may experience ongoing symptoms related to other wrist conditions. The torus fracture appears to have resolved without long-term complications based on the conservative management typical for such injuries.
Imaging
- 20 October 1986 - X-ray right wrist: Minor torus type fracture of the distal ulnar metaphysis with no major displacement or angulation.
1. What is the formal diagnosis of the condition claimed above?
Right Wrist Minor Torus Fracture of Distal Ulna - DVA SOP: Fracture No. 63 of 2024 (Balance of Probabilities), ICD-10: S52.61
A torus fracture, also known as a buckle fracture, is a type of incomplete fracture where the cortex of the bone buckles or bulges outward without complete disruption of the bone structure. This type of fracture commonly occurs in the metaphyseal region of long bones, particularly in the distal radius and ulna. Torus fractures typically result from compressive forces applied along the long axis of the bone, such as occurs during a fall on an outstretched hand. The fracture pattern involves buckling of the cortical bone without significant displacement or angulation. These fractures are considered stable injuries and usually heal well with conservative management including immobilization. The term "torus" refers to the rounded bulge appearance of the buckled cortex on radiographic imaging.
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 of right wrist pain after a fall on an outstretched hand on 20 October 1986. [MILLER MOORE PARTNERS RADIOLOGISTS, UMR - 200 - 400.pdf, Pages 17, 19, 22]
When did the veteran first present to a health / medical provider for this condition? The veteran first presented to a healthcare provider on 20 October 1986 for evaluation of right wrist pain following the fall. The specific healthcare provider is not identified in the radiological report. [MILLER MOORE PARTNERS RADIOLOGISTS, UMR - 200 - 400.pdf, Pages 17, 19, 22]
When was the condition confirmed / formally diagnosed? The minor torus fracture of the distal ulna was confirmed and formally diagnosed on 20 October 1986 via X-ray imaging performed by Miller Moore Partners Radiologists, which demonstrated the fracture with no major displacement or angulation. [MILLER MOORE PARTNERS RADIOLOGISTS, UMR - 200 - 400.pdf, Pages 17, 19, 22]
When did the veteran first present to you (or your practice) for this condition? 12 July 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 20 October 1986. Key symptoms included right wrist pain localized to the distal ulna following a fall on an outstretched hand. The investigation results showed a minor torus type fracture of the distal ulnar metaphysis with no major displacement or angulation. The fracture was considered stable based on the radiographic findings. [MILLER MOORE PARTNERS RADIOLOGISTS, UMR - 200 - 400.pdf, Pages 17, 19, 22]
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 ulna 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 promptly via X-ray and appears to have been managed appropriately for a stable torus fracture.
Note: This condition has an onset date of 20 October 1986, 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 torus fracture is not a sequelae of another known condition but appears to be a primary injury from the fall mechanism.
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 torus fracture was diagnosed promptly via X-ray imaging and appears to have been managed conservatively as appropriate for this type of stable fracture. 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. 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
