![]() Persisting clinical suspicion after negative repeat radiographs warrants Magnetic Resonance Imaging (MRI) or Computed Tomography (CT). If early confirmation is needed, bone scans can be done to diagnose occult fractures at 72 hours post-injury. If high clinical suspicion exists, the wrist should undergo immobilization in a splint or cast for 7-14 days and plain radiographs repeated. The estimates are that up to 25% of scaphoid fractures are not evident on initial plain radiographs. The evaluation begins with PA and lateral views of the wrist alongside scaphoid views, taken with the wrist at approximately 30 degrees of extension and 20 degrees of ulnar deviation. There may also be tenderness over the scaphoid tubercle on the volar aspect, which can be felt as the bony prominence radial to flexor carpi radialis at the level of the distal palmar crease. Tenderness usually presents in one of three locations: The snuffbox is the area between the first and third extensor compartments with abductor pollicis longus and extensor pollicis brevis tendons lying radially, and the extensor pollicis longus tendon lying on the ulnar side. Classically, there is tenderness in the anatomic snuffbox dorsally, especially with wrist fractures. The deformity is unlikely unless there is associated carpus dislocation, for example, perilunate dislocations. It is important to palpate over the distal radius and ulna and metacarpals to assess for any associated injury. Įxamination of the wrist should follow the “look, feel, move” pattern. It is important to ascertain if the patient is a smoker as this increases the risk of non-union by approximately 20%. ![]() There may be associated swelling and a reduced range of wrist motion. Pain is often centered on the radial side of the wrist and is worse with movement. Often the patients present late as the injury gets missed on plain radiographs. Patients will typically present with wrist pain after a recent history of trauma. Accessed May 22, 2017.Scaphoid fractures most commonly cause pain and swelling at the base of the thumb in the anatomic snuffbox. Do nonsteroidal anti-inflammatory drugs affect bone healing? A critical analysis. National Institute for Arthritis and Musculoskeletal and Skin Diseases. Current Reviews in Musculoskeletal Medicine. American Academy of Orthopaedic Surgeons. Overview of finger, hand, and wrist fractures. American Society for Surgery of the Hand. Wear wrist guards for high-risk activities, such as: Use protective gear for athletic activities ![]()
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