Posted: May 17 2020 #(C101466) Naval Medical Center Portsmouth

Scaphoid Waist Fracture in 17M High-level Athlete

HPI

17 year old right hand dominant male was playing basketball and sustained a ground level fall onto his outstretched right hand. He felt immediate radial sided wrist pain with painful range of motion and pain with lifting.

PMH

Non-contributory

Mild ecchymosis over the radial wrist. Wrist range of motion limited due to pain. Makes a composite fist with grip strength limited by pain. Tender to palpation in the anatomic snuffbox. Radial, median, ulnar motor nerves intact, SILT, and 2+ radial and ulnar pulses.

Poll

1 of 10

1. Would you obtain additional imaging studies other than standard wrist and navicular view radiographs to determine treatment?

No - current radiographs are sufficient

53%

889/1667

Yes - CT scan of the wrist in plane of the scaphoid

33%

557/1667

Yes - MRI of the wrist

144/1667

Yes - CT scan and MRI of the wrist

45/1667

Outside my area of expertise - best if I dont vote

32/1667

2. How would you manage this patient?

Nonoperative

70%

1146/1622

Operative

27%

439/1622

Outside my area of expertise - best if I don't vote

37/1622

3. If you choose Nonoperative Management, what technique would you use?

I would not choose Nonoperative Management

119/1596

Short arm cast - thumb Free

17%

282/1596

Short arm cast - thumb Immobilized (spica)

61%

987/1596

Long arm cast - thumb Free

15/1596

Long arm cast - thumb Immobilized (spica)

10%

169/1596

Outside my area of expertise - best if I don't vote

24/1596

4. If you choose Nonoperative Management, how long would you immobilize the patient?

I would not choose Nonoperative Management

82/1562

3 weeks, then convert to removable splint

129/1562

6 weeks

37%

582/1562

8 weeks

30%

470/1562

12 weeks

16%

255/1562

>12 weeks

17/1562

Outside my area of expertise - best if I don't vote

27/1562

5. If you choose Nonoperative Management in a cast, when would you allow the patient to return to sport?

I would not choose Nonoperative Managment

92/1499

Patient can play non-contact sports during cast treatment

17%

264/1499

Patient can play contact sports during treatment

35/1499

Patient cannot return to sport until radiographic fracture union and asymptomatic exam

71%

1077/1499

Outside my area of expertise - best if I dont vote

31/1499

6. If you choose Operative Management, what surgery and approach would you perform?

I would not choose Operative Management

30%

454/1485

ORIF with Screw fixation - Volar

11%

166/1485

ORIF with Screw fixation - Dosal

12%

181/1485

ORIF with Plate fixation - Volar

3/1485

ORIF with Plate fixation - Dorsal

7/1485

Percutaneous screw fixation - Volar

23%

347/1485

Percutaneous screw fixation - Dorsal

17%

259/1485

Outside my area of expertise - best if I don't vote

68/1485

7. 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

10%

138/1282

No immobilization

115/1282

1 - 2 weeks

18%

233/1282

3 - 4 weeks

24%

310/1282

5 - 6 weeks

27%

350/1282

7 - 8 weeks

61/1282

> 8 weeks

18/1282

Outside my area of expertise - best if I don't vote

57/1282

8. Assuming you performed Percutaneous screw fixation and obtained the fixation seen below, when are you allowing the patient to return to non-contact sport?

I would not choose Percutaneous screw fixation

101/1202

Immediately in a cast

30/1202

1-2 Weeks Post-operatively

51/1202

3-4 Weeks Post-operatively

117/1202

5-6 Weeks Post-operatively

20%

251/1202

7-8 Weeks Post-operatively

15%

187/1202

>8 Weeks Post-operatively

34%

411/1202

Outside my area of expertise - best if I don't vote

54/1202

9. Assuming you performed Percutaneous screw fixation and obtained the fixation seen below, when are you allowing the patient to return to contact sport?

I would not choose Percutaneous screw fixation

90/1151

Immediately in a cast

5/1151

1-2 Weeks Post-operatively

6/1151

3-4 Weeks Post-operatively

18/1151

5-6 Weeks Post-operatively

68/1151

7-8 Weeks Post-operatively

97/1151

>8 Weeks Post-operatively

70%

816/1151

Outside my area of expertise - best if I don't vote

51/1151

10. Assuming you choose Operative management, how do you access fracture union?

Physical Exam/Tenderness only

58/1201

Xrays only

23%

284/1201

Xrays + CT scan routinely in all patients

16%

193/1201

Xrays + CT scan only if they are an athlete

81/1201

Xrays + CT scan only if worried about delayed or non-union

44%

539/1201

Outside my area of expertise - best if I dont vote

46/1201

Intra-procedure P1

Post-procedure P1

All Videos (2) Podcasts (0)

Sort by

L1\L2 Evidence

Date