MCQ Orthopedics Answer 25

The correct answer is E

Fracture of the scaphoid should be suspected in every "sprained wrist" where there is tenderness in the anatomic snuffbox. Radiographs may be negative initially. The scaphoid circulation enters the bone for the most part through the distal half. Fractures through the proximal third tend to cause loss of circulation and are slower to heal, and should be referred to an orthopedist because of the risk of nonunion and avascular necrosis. Fractures through the middle or distal one-third can be handled by the family physician in consultation with an orthopedist. The fracture is treated with a thumb spica cast for 10-12 weeks. A wrist splint does not provide adequate immobilization. A bone scan is unnecessary, and physical therapy is inappropriate. If there is still no evidence of union after 10 weeks of immobilization, the patient should be referred to an orthopedist for further care.

Ref: Steinberg GG, Akins CM, Baran DT (eds): Orthopaedics in Primary Care, ed 3. Lippincott Williams & Wilkins, 1999, pp 129-130.

Category: Orthopedics MCQs