Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Scaphoid Fracture
Posted: May 17 2020 #(C101466)
A

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

PE

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%
894/1680
Yes - CT scan of the wrist in plane of the scaphoid
33%
561/1680
Yes - MRI of the wrist
8%
146/1680
Yes - CT scan and MRI of the wrist
2%
46/1680
Outside my area of expertise - best if I dont vote
1%
33/1680
2. How would you manage this patient?
Nonoperative
70%
1154/1635
Operative
27%
444/1635
Outside my area of expertise - best if I don't vote
2%
37/1635
3. If you choose Nonoperative Management, what technique would you use?
I would not choose Nonoperative Management
7%
120/1607
Short arm cast - thumb Free
17%
283/1607
Short arm cast - thumb Immobilized (spica)
61%
994/1607
Long arm cast - thumb Free
0%
15/1607
Long arm cast - thumb Immobilized (spica)
10%
170/1607
Outside my area of expertise - best if I don't vote
1%
25/1607
4. If you choose Nonoperative Management, how long would you immobilize the patient?
I would not choose Nonoperative Management
5%
84/1572
3 weeks, then convert to removable splint
8%
130/1572
6 weeks
37%
585/1572
8 weeks
30%
473/1572
12 weeks
16%
255/1572
>12 weeks
1%
17/1572
Outside my area of expertise - best if I don't vote
1%
28/1572
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
6%
94/1509
Patient can play non-contact sports during cast treatment
17%
265/1509
Patient can play contact sports during treatment
2%
36/1509
Patient cannot return to sport until radiographic fracture union and asymptomatic exam
71%
1083/1509
Outside my area of expertise - best if I dont vote
2%
31/1509
6. If you choose Operative Management, what surgery and approach would you perform?
I would not choose Operative Management
30%
456/1494
ORIF with Screw fixation - Volar
11%
169/1494
ORIF with Screw fixation - Dosal
12%
184/1494
ORIF with Plate fixation - Volar
0%
3/1494
ORIF with Plate fixation - Dorsal
0%
7/1494
Percutaneous screw fixation - Volar
23%
347/1494
Percutaneous screw fixation - Dorsal
17%
259/1494
Outside my area of expertise - best if I don't vote
4%
69/1494
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%
139/1290
No immobilization
8%
115/1290
1 - 2 weeks
18%
234/1290
3 - 4 weeks
24%
313/1290
5 - 6 weeks
27%
352/1290
7 - 8 weeks
4%
61/1290
> 8 weeks
1%
18/1290
Outside my area of expertise - best if I don't vote
4%
58/1290
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
8%
102/1210
Immediately in a cast
2%
30/1210
1-2 Weeks Post-operatively
4%
51/1210
3-4 Weeks Post-operatively
9%
118/1210
5-6 Weeks Post-operatively
20%
254/1210
7-8 Weeks Post-operatively
15%
187/1210
>8 Weeks Post-operatively
34%
413/1210
Outside my area of expertise - best if I don't vote
4%
55/1210
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
7%
91/1158
Immediately in a cast
0%
5/1158
1-2 Weeks Post-operatively
0%
6/1158
3-4 Weeks Post-operatively
1%
18/1158
5-6 Weeks Post-operatively
5%
68/1158
7-8 Weeks Post-operatively
8%
97/1158
>8 Weeks Post-operatively
70%
821/1158
Outside my area of expertise - best if I don't vote
4%
52/1158
10. Assuming you choose Operative management, how do you access fracture union?
Physical Exam/Tenderness only
4%
58/1209
Xrays only
23%
286/1209
Xrays + CT scan routinely in all patients
16%
194/1209
Xrays + CT scan only if they are an athlete
6%
81/1209
Xrays + CT scan only if worried about delayed or non-union
44%
544/1209
Outside my area of expertise - best if I dont vote
3%
46/1209
PROCEDURE #1

Volar Percutaneous Screw Fixation

Intra-procedure P1
icon
OUTCOMES
Post-procedure P1
Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options