-
Select a Community
- MB 1 Preclinical Medical Students
- MB 2/3 Clinical Medical Students
- ORTHO Orthopaedic Surgery
-
About Bullet Health
Please confirm topic selection
Are you sure you want to trigger topic in your Anconeus AI algorithm?
Acute Scaphoid Fracture in 26M
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.
1.
In addition to the current plain radiographs, would you obtain additional imaging studies to guide treatment?
No - Current radiographs are sufficient
46%
526/1141
Yes - additional radiographic views (aXR)
10%
117/1141
Yes - CT scan of the wrist (CT)
32%
371/1141
Yes - MRI scan of the wrist (MRI)
4%
49/1141
Yes - aXR + CT
3%
36/1141
Yes - aXR + MRI
0%
10/1141
Yes - CT + MRI
0%
7/1141
Yes - aXR + CT + MRI
0%
3/1141
Outside my area of expertise - best if I don't vote
1%
22/1141
2.
Would you use a classification system to guide management?
No - a classification system would not help me
58%
606/1041
Yes - Russe
10%
108/1041
Yes - Mayo
11%
124/1041
Yes - Other
6%
68/1041
Outside my area of expertise - best if I don't vote
12%
135/1041
3.
How would you manage this patient?
Nonoperative
36%
358/994
Operative
60%
600/994
Outside my area of expertise - best if I don't vote
3%
36/994
4.
If you choose Nonoperative Management, what technique would you use?
I would not choose Nonoperative Management
27%
258/950
Short arm cast - thumb Free
11%
112/950
Short arm cast - thumb Immobilized (spica)
46%
446/950
Long arm cast - thumb Free
0%
8/950
Long arm cast - thumb Immobilized (spica)
11%
107/950
Outside my area of expertise - best if I don't vote
2%
19/950
5.
If you choose Nonoperative management, how long would you immobilize in the cast?
I would not choose Nonoperative management
16%
165/1012
2 - 3 weeks OR until union confirmed
0%
8/1012
4 - 5 weeks OR until union confirmed
9%
92/1012
6 - 7 weeks OR until union confirmed
33%
339/1012
8 - 9 weeks OR until union confirmed
23%
233/1012
10 - 11 weeks OR until union confirmed
5%
53/1012
12 -13 weeks OR until union confirmed
9%
100/1012
13 or greater weeks OR until union confirmed
0%
6/1012
Outside my area of expertise - best if I don't vote
1%
16/1012
6.
If you choose Nonoperative Management, how would you confirm fracture union?
I would not choose Nonoperative management
10%
106/979
Physical exam (PEx) only
1%
10/979
Radiographs (XR) only
22%
216/979
CT scan of the wrist (CT) only
24%
235/979
XR + PEx
21%
213/979
CT + PEx
4%
41/979
CT + XR
7%
74/979
CT + XR + PEx
6%
64/979
Outside my area of expertise - best if I don't vote
2%
20/979
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%
77/872
Admit to hospital - perform surgery Same day
6%
60/872
Admit to hospital - perform surgery Next day
15%
138/872
Discharge - operate at Hospital - within 5 days
24%
212/872
Discharge - operate at Hospital - within 10 days
12%
111/872
Discharge - operate at Hospital - no time limit
1%
12/872
Discharge - operate at Surgery Center - within 5 days
11%
102/872
Discharge - operate at Surgery Center - within 10 days
12%
105/872
Discharge - operate at Surgery Center - no time limit
1%
14/872
Outside my area of expertise - best if I don't vote
4%
41/872
8.
If you choose Operative Management, what surgery and approach would you perform?
I would not choose Operative Management
5%
47/850
ORIF with Screw fixation - Volar
25%
216/850
ORIF with Screw fixation - Dosal
21%
184/850
ORIF with Plate fixation - Volar
0%
6/850
ORIF with Plate fixation - Dorsal
0%
7/850
Percutaneous screw fixation - Volar
25%
220/850
Percutaneous screw fixation - Dorsal
13%
112/850
Outside my area of expertise - best if I don't vote
6%
58/850
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%
22/765
No immobilization
8%
66/765
1 - 2 weeks
20%
154/765
3 - 4 weeks
26%
202/765
5 - 6 weeks
31%
241/765
7 - 8 weeks
5%
45/765
> 8 weeks
0%
5/765
Outside my area of expertise - best if I don't vote
3%
30/765
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%
38/716
No - I would not use a bone stimulator
75%
538/716
Yes - bone stimulator for 1 - 3 weeks
5%
41/716
Yes - bone stimulator for 4 - 6 weeks
5%
40/716
Yes - bone stimulator for 7 - 10 weeks
0%
6/716
Outside my area of expertise - best if I don't vote
7%
53/716
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%
24/692
Immediately - in cast - before radiographic confirmation of union
2%
19/692
2 -3 weeks - in cast - before radiographic confirmation of union
4%
31/692
4 - 6 weeks - in cast - before radiographic confirmation of union
9%
68/692
After confirmation of union by Xray - in Cast
8%
58/692
After confirmation of union by Xray - without Cast
37%
262/692
After confirmation of union by CT - in Cast
6%
43/692
After confirmation of union by CT - without Cast
22%
156/692
Outside my area of expertise - best if I don't vote
4%
31/692
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%
25/676
Immediately - in cast - before radiographic confirmation of union
0%
1/676
2 -3 weeks - in cast - before radiographic confirmation of union
0%
4/676
4 - 6 weeks - in cast - before radiographic confirmation of union
4%
29/676
After confirmation of union by Xray - in Cast
5%
40/676
After confirmation of union by Xray - without Cast
41%
280/676
After confirmation of union by CT - in Cast
6%
47/676
After confirmation of union by CT - without Cast
32%
218/676
Outside my area of expertise - best if I don't vote
4%
32/676
PROCEDURE #1
Closed reduction and percutaneous screw fixation of left scaphoid waist fracture via volar approach
Intra-procedure P1
OUTCOMES
Post-procedure P1