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 interest in
operating on these.
--> And where, pray tell, does one still find tubigrip nowadays? And why?
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