Approach to extremity injury Quiz: Ace Your Exams

A 32-year-old woman presents to the emergency department after a fall while intoxicated. The patient was found down at the bottom of a stairwell, having tripped while trying to walk to the restroom after sleeping in a chair all night. The patient drinks 8-10 beers daily and has a history of prior hospitalizations for alcohol withdrawal. Otherwise, there is no significant past medical history and no home medication. Temperature is 37.0°C (98.6°F), heart rate is 108/min, respiratory rate is 16/min, blood pressure is 154/82 mmHg, and oxygen saturation is 97% on room air. On primary survey, the patient speaks in full sentences. Bilateral breath sounds are clear, and there is no active bleeding. Glasgow coma score (GCS) is 15. Scattered abrasions are noted over the legs and back, and there is a soft tissue hematoma over the forehead. A full trauma workup, including radiographs and computed tomography, reveals four left rib fractures and a 3 mm left fronto-temporal subdural hemorrhage without midline shift. The patient is admitted to the trauma intensive care unit and is later observed to have impaired left wrist extension without overlying evidence of injury, deformity, or sensory loss. Neurological examination is otherwise unremarkable. Which of the following is the best next step in management of the wrist?