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ACAD-AE-MED  June 2004

ACAD-AE-MED June 2004

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Subject:

Re: is it a scaphoid fracture?

From:

"[log in to unmask]" <[log in to unmask]>

Reply-To:

Accident and Emergency Academic List <[log in to unmask]>

Date:

Tue, 22 Jun 2004 03:58:44 -0400

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (99 lines)

Last November whilst diving abroad and I slipped and sprained my wrist. The
next morning I really was not sure whether I'd fractured my scaphoid so
went for an x-ray. The x-ray was normal but they wanted to POP it anyway of
course. I was determined to dive and so got a wrist splint. I had it
re-x-rayed two weeks later because I still wasn't sure but it was
improving. Since then it has got exponentially better, but what I did find
was that I had difficulty mobilising the wrist as the haematoma became
organised. It made chest comnpressions difficult for a while. I wonder how
many people have permanent loss of range because they are rigidly
immobilised for long enough to fix the joint. Are we really sure that
immobilisation is the safe and benign option to being sued? Or should we be
giving informed choice to our patients?

Vic Calland

Original Message:
-----------------
From: Simon Odum [log in to unmask]
Date: Tue, 22 Jun 2004 07:09:20 +0100
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 support
(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 interest in
operating on these.

--> And where, pray tell, does one still find tubigrip nowadays? And
why?

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