I. Imaging Findings

Based on the provided X-ray images (posteroanterior and lateral views) of the left wrist, the following can be observed:

• There is a pronounced malalignment between the distal radius and the carpal bones, with the carpal bones shifted dorsally as a whole, indicating a radiocarpal joint dislocation.
• No obvious fracture lines are noted in the radius or carpal bones; the trabecular patterns remain largely continuous.
• The soft tissue outline is not very clear on the image, but there is no visible significant soft tissue swelling or free bone fragment.

II. Potential Diagnoses

Based on the imaging findings and the mechanism of injury (fall on outstretched hand), the following primary diagnoses should be considered:

1. Radiocarpal Dislocation
   A typical presentation involves displacement between the distal radius and the entire series of carpal bones at the articular surface. The provided PA and lateral radiographs show notable dorsal displacement, consistent with the clinical findings.
2. Distal Radioulnar Joint Dislocation with Wrist Injury
   Some patients may have coexisting distal radioulnar joint instability, which should be ruled out during clinical assessment.
3. Associated Fractures or Ligament Injuries (e.g., Distal Radius Fracture, Scaphoid Fracture, Wrist Ligament Tears, etc.)
   If there are subtle fracture lines or ligament tears, they may not be readily visible on initial X-rays. A CT or MRI may be required if there is any suspicion.

III. Final Diagnosis

Taking into account the mechanism of injury (fall on outstretched left hand), clinical presentation (severe wrist pain, functional impairment, obvious deformity), and radiographic findings (dorsal displacement of the radiocarpal joint), the most likely diagnosis is: Dorsal Radiocarpal Joint Dislocation of the Left Wrist. A closed reduction has been performed under local anesthesia.

If there is clinical suspicion of coexisting fractures or significant ligament injuries, further evaluation with CT or MRI may be warranted.

IV. Treatment Plan and Rehabilitation

1. Treatment Strategy

• Conservative treatment: For isolated radiocarpal dislocations with satisfactory reduction, a cast or splint may be used to immobilize the wrist in a neutral position for 4–6 weeks, with regular follow-up imaging to ensure joint stability.
• Surgical treatment: If there is serious ligament damage, an unstable dislocation, or an associated fracture, ligament repair or fracture fixation may be required. Patients with notable instability or recurrent dislocations may also need surgical intervention.

2. Rehabilitation / Exercise Prescription (Example following FITT-VP principles)

• Immobilization and Rest Phase (0–4 weeks)
  • Wear a cast or splint to restrict wrist motion.
  • Perform active exercises for the shoulder, elbow, and fingers to prevent stiffness in adjacent joints.
  • Monitor pain, swelling, and skin condition.
• Early Recovery Phase (4–6 weeks)
  • After medical evaluation, gradually remove the cast or splint and begin progressive passive and active range-of-motion exercises for the wrist, starting with short durations and gradually increasing.
  • Frequency (F): 2–3 times per day
  • Intensity (I): Light to moderate, avoiding significant pain
  • Time (T): 10–15 minutes per session
  • Type (T): Wrist flexion-extension, pronation-supination exercises
  • Progression (P): Gradually increase range of motion and frequency daily or weekly as tolerated.
• Functional Strengthening Phase (after 6–8 weeks)
  • Begin grip-strengthening exercises and wrist resistance training (e.g., using a grip ball or light resistance band).
  • Incorporate core stability and upper limb coordination drills to prevent reinjury.
  • Adjust loads weekly based on recovery progress and medical advice.
• Return-to-Activity Phase (8 weeks or later)
  • Once the wrist is stable and sufficiently strong, gradually resume daily activities and sports.
  • For high-impact or contact sports (e.g., rugby, basketball), a minimum of 10–12 weeks of rehabilitation is generally recommended, with specialist clearance before returning to play.

Regular follow-up is essential throughout rehabilitation. If significant pain, restricted joint movement, or persistent instability of the reduction occurs, further imaging and adjustment of the treatment plan may be necessary.

Disclaimer

This report is based on the provided clinical history and imaging data as a reference for analysis and does not replace in-person medical evaluation or professional medical advice. If you have questions, please consult an orthopedic specialist and arrange further examinations or treatment plans according to the patient's specific condition.