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This week's wrist
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This week's wrist - May 15, 2005 10:59:00 PM
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Alex Brenner PT MPT OCS
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From: Kentucky
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Patient walked in to direct access physical therapy complaining of dorsal wrist pain after slipping and falling on the wet grass this morning. He has mild to moderate swelling. X-rays are below.
(all images obtained and used with permission)
[IMG]http://img.photobucket.com/albums/v85/brennerak/distalwrist.jpg[/IMG]
What are the findings?
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Alex Brenner, PT, MPT, OCS
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Re: This week's wrist - May 16, 2005 3:07:00 AM
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Jon Newman
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I'll start with the hooves' of horses--Non-displaced Colles' fracture, but admittedly this is a guess.
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: This week's wrist - May 16, 2005 4:48:00 AM
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JLS_PT_OCS
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From: USA
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Maybe it's my monitor (the ultimate copout) but the lateral view is not clear enough to see much.
Good thing his scaphoid fracture is so obvious on the AP view. Splint him, and off he goes to Orthopedics.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: This week's wrist - May 16, 2005 7:14:00 AM
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steve
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From: victoria, bc Canada
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Agree with Jason, nothing can be seen on the lateral view but he has an obvious scaphoid fracture.
Steve
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Re: This week's wrist - May 16, 2005 7:44:00 AM
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KAK
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Scaphoid fracture.
lateral view-? fracture distal radius.
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Re: This week's wrist - May 16, 2005 8:54:00 AM
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Jon Newman
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From: Amherst, WI
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Oh Jason, I was just leaving the obvious stuff to someone else. It had nothing to do with me completely missing it (laugh here).
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: This week's wrist - May 16, 2005 8:58:00 AM
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JLS_PT_OCS
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No worries, Jon.
I assumed you saw it and were throwing us a red herring.
:)
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: This week's wrist - May 16, 2005 2:30:00 PM
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jma
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Joined: August 24, 2000
From: NY
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Scaphoid fracture won A/P view ith obvious dorsal swelling on lateral view.
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Re: This week's wrist - May 17, 2005 1:01:00 AM
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fapt
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From: Taiwan, R.O.C.
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The patient had the Scaphoid fx...
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Re: This week's wrist - May 17, 2005 3:07:00 PM
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jma
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Okay, what did radiology report have to say?
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Re: This week's wrist - May 30, 2005 12:55:00 AM
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Alex Brenner PT MPT OCS
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From: Kentucky
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Sorry, I have been away for a few weeks doing the military thing.
There is a fracture through the schaphoid making it appear like two separate bones, thus really testing your anatomy of the carpal bones. A fracture like this can sometimes be easily overlooked on the first glance.
[IMG]http://img.photobucket.com/albums/v85/brennerak/schapoidfx2.jpg[/IMG]
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Alex Brenner, PT, MPT, OCS
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Re: This week's wrist - May 30, 2005 2:46:00 AM
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jma
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From: NY
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Thanks for the update. Keep the images coming when you have time to post them.
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Re: This week's wrist - June 2, 2005 1:24:00 AM
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JLS_PT_OCS
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Followup question - how do you manage this injury?
Why is appropriate management important?
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: This week's wrist - June 2, 2005 2:15:00 AM
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Sebastian Asselbergs
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From: Barrie, Canada
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I bet you're fishing for the vascular risk here, Jason....High risk in these scaphoid fractures to develop avascular necrosis.
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Re: This week's wrist - June 2, 2005 2:31:00 AM
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KAK
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They are at higher risk for non-union for the same reason (poor vascular supply). If the fracture is displaced, I believe surgery is indicated, otherwise immobilization-sometimes prolonged.
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Re: This week's wrist - June 6, 2005 9:07:00 PM
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Ann McChesney
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From: New Zealand
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The proximal pole # is more at risk of avascular necrosis. This is (I think ) a waist #, so treated in POP for 8 weeks.
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Re: This week's wrist - June 7, 2005 6:42:00 AM
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JLS_PT_OCS
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From: USA
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Sebastian got it, and Kathy said the same thing. Definitely a case for the people in Orthopedics to see and make the call on, splint and refer...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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