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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? _________________________________________________________________ Want to block unwanted pop-ups? Download the free MSN Toolbar now! http://toolbar.msn.co.uk/ --- Incoming mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.707 / Virus Database: 463 - Release Date: 15/06/2004 --- Outgoing mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.707 / Virus Database: 463 - Release Date: 15/06/2004 -------------------------------------------------------------------- mail2web - Check your email from the web at http://mail2web.com/ .