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HPI

A 26-year-old right hand dominant male presents to the emergency room with left wrist pain after falling off his skateboard the same day. He denies any prior injury to the wrist. He denies numbness and tingling.

PMH

Non Smoker, PMH negative

PE

Focused left upper extremity examination reveals no open wounds. There is tenderness over the distal scaphoid pole and snuffbox. There is no tenderness to palpation over the distal radius. Sensation is intact to median, radial and ulnar nerve distributions. Motor function is intact in the anterior interosseous nerve, posterior interosseous nerve, and ulnar nerve. Fingers are pink and well-perfused. No other skin changes noted.

Poll
1 of 12
1. In addition to the current plain radiographs, would you obtain additional imaging studies to guide treatment?
No - Current radiographs are sufficient
46%
535/1155
Yes - additional radiographic views (aXR)
10%
117/1155
Yes - CT scan of the wrist (CT)
32%
376/1155
Yes - MRI scan of the wrist (MRI)
4%
49/1155
Yes - aXR + CT
3%
36/1155
Yes - aXR + MRI
0%
10/1155
Yes - CT + MRI
0%
7/1155
Yes - aXR + CT + MRI
0%
3/1155
Outside my area of expertise - best if I don't vote
1%
22/1155
2. Would you use a classification system to guide management?
No - a classification system would not help me
58%
614/1052
Yes - Russe
10%
109/1052
Yes - Mayo
11%
125/1052
Yes - Other
6%
68/1052
Outside my area of expertise - best if I don't vote
12%
136/1052
3. How would you manage this patient?
Nonoperative
36%
364/1006
Operative
60%
606/1006
Outside my area of expertise - best if I don't vote
3%
36/1006
4. If you choose Nonoperative Management, what technique would you use?
I would not choose Nonoperative Management
27%
261/962
Short arm cast - thumb Free
11%
113/962
Short arm cast - thumb Immobilized (spica)
47%
453/962
Long arm cast - thumb Free
0%
8/962
Long arm cast - thumb Immobilized (spica)
11%
107/962
Outside my area of expertise - best if I don't vote
2%
20/962
5. If you choose Nonoperative management, how long would you immobilize in the cast?
I would not choose Nonoperative management
16%
166/1024
2 - 3 weeks OR until union confirmed
0%
9/1024
4 - 5 weeks OR until union confirmed
9%
94/1024
6 - 7 weeks OR until union confirmed
33%
343/1024
8 - 9 weeks OR until union confirmed
22%
235/1024
10 - 11 weeks OR until union confirmed
5%
53/1024
12 -13 weeks OR until union confirmed
9%
101/1024
13 or greater weeks OR until union confirmed
0%
6/1024
Outside my area of expertise - best if I don't vote
1%
17/1024
6. If you choose Nonoperative Management, how would you confirm fracture union?
I would not choose Nonoperative management
10%
106/990
Physical exam (PEx) only
1%
10/990
Radiographs (XR) only
22%
219/990
CT scan of the wrist (CT) only
24%
238/990
XR + PEx
21%
215/990
CT + PEx
4%
42/990
CT + XR
7%
75/990
CT + XR + PEx
6%
64/990
Outside my area of expertise - best if I don't vote
2%
21/990
7. If you choose Operative management, considering the patient presented to the ER at 2 PM on a weekday on the day of injury, what would be your time frame to take him to surgery and where would you do it?
I would not choose Operative Management
8%
78/883
Admit to hospital - perform surgery Same day
6%
61/883
Admit to hospital - perform surgery Next day
15%
138/883
Discharge - operate at Hospital - within 5 days
24%
216/883
Discharge - operate at Hospital - within 10 days
12%
111/883
Discharge - operate at Hospital - no time limit
1%
12/883
Discharge - operate at Surgery Center - within 5 days
11%
105/883
Discharge - operate at Surgery Center - within 10 days
12%
107/883
Discharge - operate at Surgery Center - no time limit
1%
14/883
Outside my area of expertise - best if I don't vote
4%
41/883
8. If you choose Operative Management, what surgery and approach would you perform?
I would not choose Operative Management
5%
48/860
ORIF with Screw fixation - Volar
25%
218/860
ORIF with Screw fixation - Dosal
21%
185/860
ORIF with Plate fixation - Volar
0%
6/860
ORIF with Plate fixation - Dorsal
0%
7/860
Percutaneous screw fixation - Volar
25%
223/860
Percutaneous screw fixation - Dorsal
13%
115/860
Outside my area of expertise - best if I don't vote
6%
58/860
9. Assuming you performed Percutaneous screw fixation and obtained the fixation seen below, how long do you immobilize post-operatively?
I would not choose Percutaneous screw fixation
2%
22/775
No immobilization
8%
66/775
1 - 2 weeks
19%
154/775
3 - 4 weeks
26%
204/775
5 - 6 weeks
32%
248/775
7 - 8 weeks
5%
45/775
> 8 weeks
0%
6/775
Outside my area of expertise - best if I don't vote
3%
30/775
10. If you choose Percutaneous screw fixation - Volar and postoperative immobilization, would you use bone stimulation to promote healing?
I would no choose Percutaneous screw fixation - Volar
5%
38/726
No - I would not use a bone stimulator
75%
547/726
Yes - bone stimulator for 1 - 3 weeks
5%
41/726
Yes - bone stimulator for 4 - 6 weeks
5%
40/726
Yes - bone stimulator for 7 - 10 weeks
0%
7/726
Outside my area of expertise - best if I don't vote
7%
53/726
11. If you choose Percutaneous screw fixation - Volar and obtained the construct below, considering it is his non-dominant hand, when would you allow return to NON-contact sports? (soccer, tennis)
I would not choose Percutaneous screw fixation - Volar
3%
24/702
Immediately - in cast - before radiographic confirmation of union
2%
19/702
2 -3 weeks - in cast - before radiographic confirmation of union
4%
31/702
4 - 6 weeks - in cast - before radiographic confirmation of union
9%
68/702
After confirmation of union by Xray - in Cast
8%
60/702
After confirmation of union by Xray - without Cast
37%
266/702
After confirmation of union by CT - in Cast
6%
43/702
After confirmation of union by CT - without Cast
22%
159/702
Outside my area of expertise - best if I don't vote
4%
32/702
12. If you choose Percutaneous screw fixation - Volar and obtained the construct below, considering it is his non-dominant hand, when would you allow return to Contact sports? (skateboarding, football, skiing)
I would not choose Percutaneous screw fixation - Volar
3%
25/686
Immediately - in cast - before radiographic confirmation of union
0%
1/686
2 -3 weeks - in cast - before radiographic confirmation of union
0%
4/686
4 - 6 weeks - in cast - before radiographic confirmation of union
4%
29/686
After confirmation of union by Xray - in Cast
5%
40/686
After confirmation of union by Xray - without Cast
41%
284/686
After confirmation of union by CT - in Cast
6%
47/686
After confirmation of union by CT - without Cast
32%
224/686
Outside my area of expertise - best if I don't vote
4%
32/686
PROCEDURE #1

Closed reduction and percutaneous screw fixation of left scaphoid waist fracture via volar approach

Intra-procedure P1
icon
OUTCOMES
Post-procedure P1
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