Question

5. An athlete experiences a FOOSH mechanism and has radial side wrist pain. You suspect a scaphoid fracture - which fracture test would be ideal for this assessment prior to sending for x-rays?

2. The x-ray comes back negative but the athlete is still in a lot of pain. How will you manage the injury in the short term and why?

3. What is the risk if this injury isn’t managed properly? If misdiagnosed, what follow up care is required?  
4. What 3 other injuries might this athlete have suffered with the mechanism? Be specific about the structure and type of injury.

Answer 1

Ans:

• Fall On Out Stretch Hand may lead to scaphoid fracture. Initial assessment will be find the tenderness on the base of the thumb, swelling at anatomical snuffbox occur.The idal assessment is wrist examination grasp the wrist with their thumb ove the volar aspect in order to prevent the scaphoid and move in radial deviation the pain will indicate positve test, more specific test is slight extention of wrist idicate the pain. scaphoid shift test are used for more specifically the scaphoid.
• Stable or minimaly displaced scaphoid fracture managed conservatively by cast(immobilisation of the wrist), splints,and analgesis, Displaced fracture treated as open reduction internal fixation with screw fixation which is critical coordinate with other carpal bones, scaphoid fracture have high risk of non-union, mall union, avascular necrosis.
• Scaphoid fracture is not treated radius bone will be affected,which can lead to wrist arthritis,severe pain, wrist movement specifically extention movement are affected. Sometimes misdiagnosed as wrist sprain it may lead alterd carpal movements, reduced grip strength.the fallow up will be wear recommended splint upto 2 to 3 weeks,icing may raduce the swelling, avoid movement in the affected hand.donot return to the sports activities.
• Distal radius fractures, Colle's fracture, Smith fracture,Barton's fracture.

1. Colle's fracture: Posterior displacement of the radius,the fall of mechanism is falls on pronated hand and outstretched arm,wrist extension.
2. Smith fracture:Dorsal or anterior displacement of distal radius,mechanism of injury is falling onto flexed wrist.
3. Borton's fracture:Intra articular fractureof the distal radius, dislocation of the radiocarpal jiont. fall on extended and pronated wrist increasing carpal compression force on the dorsal rim.