Anecdotes are still evidence just lower down in the hierarchy,
equivalent to a case report or case series I suppose
Andy Webster
+44 226750279 (home)
+44 7989 587971 (mobile)
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Vic Calland
Sent: 23 June 2004 13:53
To: [log in to unmask]
Subject: Re: is it a scaphoid fracture?
The advantage of anecdotal medicine is that you learn from one death
rather than have to wait until you have killed a statistically
significant number of patients.....
And who could have missed the BMJ article showing that no properly
randomised controlled trials had been conducted to show the advantage of
a parachute when jumping from a plane..
Vic Calland
-----Original Message-----
From: [log in to unmask]
[mailto:[log in to unmask]] On Behalf Of Scott, Charles
Sent: 23 June 2004 09:21
To: [log in to unmask]
Subject: Re: is it a scaphoid fracture?
Isn't that anecdote just what we are trying to get away from with
evidence
based medicine? But I remember this same discussion 20 years ago and
we
still haven't got a consensus or evidence. It was said then after the
paper
from Dickson in Oxford(?) that if you missed a fracture because it
didn't
show on the first film that fracture didn't cause problems; but I'm sure
most of us could remember a case where an early fracture was missed and
it
caused lots of problems. "Plus ca change"?. Maybe the best practice
is
"it works for me"?
> -----Original Message-----
> From: Ray McGlone [SMTP:[log in to unmask]]
> Sent: Tuesday, June 22, 2004 9:07 PM
> To: [log in to unmask]
> Subject: Re: is it a scaphoid fracture?
>
> I've been doing it for 15 years as departmental policy and not had any
> problems yet........ as they are initially splinted.
>
> Ray
>
> ----- Original Message -----
> From: ADRIAN FOGARTY <mailto:[log in to unmask]>
> To: [log in to unmask]
<mailto:[log in to unmask]>
> Sent: Tuesday, June 22, 2004 8:53 PM
> Subject: Re: is it a scaphoid fracture?
>
> Yes, I can get something for you, Ray. I wouldn't recommend
skipping
> scaphoid views on first visit however, particularly in the vulnerable
age
> group (this fracture is very rare in children and the over 40s) as
> standard wrist views will often miss an obvious waist fracture.
>
> AF
>
> Ray McGlone < [log in to unmask]
<mailto:[log in to unmask]>>
> wrote:
>
> Do you have any references for this?
>
> By the way on presentation we only do wrist views and
then
> only proceed to doing scaphoid views if they are still symptomatic at
> 10-14 days. Saves on time and radiation on first visit.
>
> Ray McGlone
> Lancaster
>
> ----- Original Message -----
> From: ADRIAN FOGARTY
> <mailto:[log in to unmask]>
> To: [log in to unmask]
> <mailto:[log in to unmask]>
> Sent: Tuesday, June 22, 2004 4:50 PM
> Subject: Re: is it a scaphoid fracture?
>
> And that's precisely why it's no longer
recommended
> to plaster the x-ray-negative suspected scaphoid fracture. Those that
do
> end up becoming visible fractures are inevitably undisplaced and do
much
> better with mobilisation.
>
> AF
>
> Simon Odum < [log in to unmask]
> <mailto:[log in to unmask]>> wrote:
>
> I suspect not as they were all undisplaced.
>
> -----Original Message-----
> From: Accident and Emergency Academic List on
behalf
> of Andy Webster
> Sent: Tue 22/06/2004 09:49
> To: [log in to unmask]
> Cc:
> Subject: Re: is it a scaphoid fracture?
>
>
>
> Would those have had any risk of complication if
you
> had just treated
> them in a splint, or even left open to the fresh
> air!!
>
> Andy Webster
> +44 226750279 (home)
> +44 7989 587971 (mobile)
>
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of
> Simon Odum
> Sent: 22 June 2004 07:09
> To: [log in to unmask]
> Subject: Re: is it a scaphoid fracture?
>
> I normally explain that I am going to x-ray
them,
> but the fracture may
> not show up on this x-ray, so either way they
are
> leaving with a suppor! t
> (POP or futuro depending on x-ray) and they are
> followed up by our
> physio practitioner at 2 weeks post
presentation.
>
> Interestingly (and anecdotally!) we have had 4
or 5
> fractured scaphoids
> that were not radiologically evident until 6-8
weeks
> post injury but
> were followed up due to persistent symptoms and
were
> all treated in POP.
>
> Simon Odum
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of
Doc
> Holiday
> Sent: 21 June 2004 23:29
> To: [log in to unmask]
> Subject: Re: is it a scaphoid fracture?
>
> Adrian wrote:
>
> The majority of patients who have "tenderness"
in
> the snuffbox following
> a
> fall on the outstretched hand DO NOT turn out to
> have a scaphoid
> fracture. I
> think it's completely wrong then to tell
everyone
> "you have a scaphoid
> fracture" as Doc has described. There are myriad
> other reasons for
> having
> ASB tenderness; scaphoid fracture! is but one,
and
> is much less common
> than a
> simple wrist sprain for example.
>
> ---> I was being brief for the sake of
clarity...
> Which is the reason
> for
> the confusion... Don't literally say "it's
broken
> 100% and I will not
> change
> my mind". Merely ACT as if it is FOR THE TIME
BEING
> and give the patient
> the
> clear impression that FOR NOW, it is how you'll
> treat it.
>
> ---> As your (far) greater experience than mine
(no
> sarcasm) will tell,
> when
> one has to appologise for or defend juniors
who've
> made a booboo in this
> case, it's always for NOT treating a fracture as
a
> fracture. Complaints
> from
> patients about treatment of their sprain as a
> fracture are rare and
> financially un-embarrassing.
>
> So in summary then, if x-rays are negative,
tubigrip
> or the like
> followed by
> A&E review 7-10 days later where many are then
> discharged. If x-rays are
> positive, simple backslab and refer to orthopod
who
> has an i! nterest in
> ope! rating on these.
>
> --> And where, pray tell, does one still find
> tubigrip nowadays? And
> why?
>
>
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