----- Original Message -----
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.
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 interest in
ope! rating
on these.
--> And where, pray tell, does one still find tubigrip
nowadays?
And
why?
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