Question

Scenario: A cheerleader is complaining of pain over the right hand/wrist. You determine that the cheerleader fell on an outstretched hand while performing a backflip at practice the previous day. Observation reveals minor swelling but no discoloration or deformity. Palpation reveals sharp pain in the anatomic snuffbox.

The injury is a scaphoid fracture

1.Discuss the injury and differential diagnosis.
2.Explain what steps you would take in managing and treating her injury.
3.Discuss the negative outcome that could result for the patient if an athletic trainer chooses conservative treatment prior to making a referral.

Answer 1

1. Scaphoid bone is unique because it links the proximal and distal row carpal bones together.

–mechanism of the injury is fall on outstreched hand with an extended, radially deviated wrist,which results in extreme dorsiflexion at the wrist and compression to the radial side of hand.

–After scaphoid fracture there is rare bruising and no deforming with minimum swelling. So it is mistaken with sprain by the trainer.

DIFFERENTIAL DIAGNOSIS :

For scaphoid fracture -

–scaphoid bone fracture symptoms can be tenderness in anatomical snuff box and compressing 2nd and 3rd metacarpals proximally may cause pain.

– scaphoid compression pain and tenderness of scaphoid tubercule could be more specific.

–Differential diagnosis for scaphoid injuries includes fracture of other metacarpal bones or the distal radius, scapholunate dissociation, arthritis, tenosynovitis or strains which can be differentiated by the location of the tenderness, pain with certain maneuvers, and radiographic abnormalities.

2. TREATMENT ‐

–Location and degree of fracture in her should be identified by diagnostic tools.

– in case of fracture near thumb the forearm and hand should be placed in a cast or splint.

–in case of fracture near forearm cast should include thumb and should extend above elbow to stabilize the fracture.

Bone stimulator should be recommended to her as it stimulates healing by delivering ultrasonic waves.

–surgical procedures should be done if it is brolen at proximal pole or the parts are displaced.

3. If scaphoid fracture is mistaken for sprain and not reffered to doctor and treated by the trainer, then

– when the fracture is not treated with immobilization then it may fail to heal called nonunion.

–avascular necrosis occurs when the fracture causes the blood supply to be cut off to the part of or all the bone leading to death of bone tissue.

–when fracture is left untreated,the part of scaphoid that interacts with radius may die,which can result in painful arthritis and permanent wrist bone deformation.