CC May 2016 Scaphoid fracture

echoecho's version from 2016-07-28 04:43


Question Answer
What symptoms would a patient have if he fell on an outstretched hand and suffered a scaphoid fracture?1) wrist pain 2) snuffbox tenderness
Falling on an outstretched hand (FOOSH) accounts for ____% of scaphoid fractures?97
Although other fractures are possible with this mechanism (FOOSH) of injury _____ x-rays generally exclude them?negative
The ______ bone is the most commonly fractured carpal bone? Accounting for ___ % to ____% of all carpal injuries?scaphoid; 60; 80
Patients typically present with a complaint of ____ wrist pain, particularly over the ______ _______?dorsal; anatomic snuffbox
Describe how the anatomic snuffbox is formed?formed by the abductor pollicis longus and extensor pollicis longus and brevis tendons
Suspicion of a caphoid fractures i often raised by the presence of tenderness where?within the anatomical snuffbox while the wrist is in ulnar deviation
Swelling, if present may be noted by the loss of the ______ of the snuffbox?concavity
Axial compression of the digit along its longitudinal axis puts pressure directly on the scaphoid and should cause pain if a fracture is present?thumb
*** What is the initial study for a suspected scaphoid fracture?x-ray
Because of the tenuous blood supply of the scaphoid bone, these fractures, especially if initially not evident with resultant delay in treatment, have an increased risk of potentially serious complications, name two of the most notable complications?1) nonunion 2) avascular necrosis
Unfortunately, ___ % to ____% of these fractures may not be visualized on initial wrist radiographs?10; 20
The fracture may also NOT be appreciated when a ______ scaphoid view is obtained?dedicated
How is a dedicated scaphoid x-ray view taken?a radiograph taken with the fist clenched and the wrist held in ulnar deviation
*** What is the standard initial management of a possible occult scaphoid fracture?1) splinting (use of long or short-arm thumb spica splint/cast 2) re-evaluation after 10-14 days
Is physical therapy appropriate?no
At the time of re-evaluation there may be x-ray evidence of what?a fracture
If x-rays at the time of re-evaluation are negative but a strong suspicion of fracture remains, the American College of Radiology recommends what?1) MRI without contrast (appropriateness criteria 9/9) OR 2) CT without contrast (aprropriateness criteria 8/9) 3) bone scan (appropriateness criteria 4/9) BUT can be POSITIVE as early as 3 days after injury
Displaced, angulated or comminuted fractures and proximal pole fractures require _____ consultation with a hand surgeon for potential operative repair?urgent
What type of procedures are preferred, if possible?minimally invasive procedures
Nondisplaced fracture are treated in a _________ splint for ____ weeks, with hand surgeon follow-up arranged?thumb-spica; 6
There are reports that a volar wirst splint may be adequate immobilization and that the thumb need not be immobilized in a _____ splint, but evidence suggest that the ____-_____ splint as preferred initial immobilization therapy?thumb; thumb-spica
What 2 conditions are potential late complication of this fracture?1) avascular necrosis 2) bone collapse
For those patients (competitive athletes) who need to return to full activity asap, delays in definitive dx and prolonged healing periods are not acceptable, true or false?true
These patients may opt for early ______ fixation so that they can return to regular activity sooner?internal
There is evidence that early advanced imaging is a cost-effective means of managing all pts with possible scaphoid fractures, true or false?true
How would De Quervain tenosynovitis present after an acute injury? Treatment?1)would not present acutely after an injury 2) corticosteroid injection would be appropriate if conservative treatment fails
Fracture of the hook of the hamate can occur after FOOSH, but the hamate is located on the _____ side of the hand and would not result in pain in the ______ region?ulnar; snuffbox
What syndrome is an overuse disorder most commonly seen in young gymnasts due to the use of wrist as a weight-bearing joint?distal radial physeal stress syndrome
What can distal radial physeal stress syndrome cause?premature closure of the distal radial physis
Wrist sprain is a possibility, but isolated tenderness in the ______ makes this less likely? What is the treatment?1) snuffbox 2) an elastic wrap and analgesics would be appropriate for wrist sprains
*** SUMMARY = Fall on an outstrestched hand (FOOSH) is the most common injury resulting in a _______ fracture?scaphoid
*** SUMMARY = The presence of tenderness within the anatomical snuffbox while the wrist is in the ________ deviation suggests a scaphoid fracture?ulnar
*** SUMMARY = Initial evaluation is a plain film, although more advanced imaging may be an option in certain cases. X-ray should be taken with the fist ______ and the wrist held in ____ deviation?clenched; ulnar
*** SUMMARY = Standard initial management of a patient with a possible occult scaphoid fracture includes _____?splinting