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Silver Fork Deformity

Exams and Signs

Historical Overview

  • The term “silver fork deformity” is derived from the injured wrist having the appearance of an overturned dinner fork.

Description

  • Silver fork deformity is a wrist injury characterized by a distal radius fracture within 2.5 cm of its distal end. The arm will resemble a fork lying horizontally, so that the base of the fork’s tines makes an upward curve. The resulting hump in the fractured arm is due to dorsal displacement of the distal radius fragment.

Pathophysiology

  • Silver fork deformity usually results from a fall on an outstretched hand (FOOSH) which leads to a distal radius fracture.

Instructions

  1. Ask the patient to place his/her arm on the table.
  2. Observe the profile of the arm.
  3. Determine if the arm resembles a fork lying horizontally, so that the base of the tines makes an upward curve.
Presentation Photos and Related Diagrams
  • Silver Fork Deformity Secondary to Distal Radius Fracture.
    Silver Fork Deformity Secondary to Distal Radius Fracture.
Definition of Positive Result
  • A positive result occurs when the arm resembles a fork lying horizontally, so that the base of the fork’s tines makes an upward curve. 
Definition of Negative Result
  • A negative result occurs when the forearm and wrist have a normal appearance when lying horizontally.
Comments and Pearls
  • In half of recorded cases, the patient will also present with fracture of the ulnar styloid process.   
Diagnoses Associated with Exams and Signs
References
  1. Bae DS, Pediatric Distal Radius and Forearm Fractures. J Hand Surg Am 2008; 33(10):1911-23.  PMID: 19084202
  2. Brown JH, DeLuca SA. Growth plate injuries: Salter-Harris classification.  Am Fam Physician 1992; 46(4):1180-4.  PMID: 1414883
  3. Griffin LY.  Essentials of Musculoskeletal Care. 3rd ed. Rosemont, IL: American Academy of Orthopedic Surgeons, 2005.
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