OBJECTIVE We developed and implemented clinical practice guideline (CPG) using computerized tomography (CT) as the initial imaging method in the emergency department management of scaphoid fractures. We hypothesized that this CPG would decrease unnecessary immobilization and lead to earlier return to work. METHODS This observational study evaluated implementation of our CPG, which incorporate...

Twenty-one patients with acute bone pain in areas other than the scaphoid were referred for isotope bone imaging directly from the A&E department. Of these scans 61% were positive. The various pathologies seen included stress fractures, osteomyelitis and bony metastases. Implications of the findings are discussed.

INTRODUCTION Standard management of scaphoid fractures is based largely on tradition and anecdote. Technological advances such as improved imaging, wrist arthroscopy, and cannulated screws are contributing to a rapid evolution in the diagnosis and management of scaphoid fractures and their sequelae. This review outlines some of the controversies surrounding scaphoid fractures, in the context of...

The aim of this study was to present a case report on pseudarthrosis of the scaphoid tubercle, a pathological condition that affects the young and active population. This entity often develops as a result of failure to make an early diagnosis and a late start to treatment. This report describes the case of a 15-year-old patient with a history of a neglected fracture of the scaphoid tubercle tha...

The natural history and treatment of scaphoid fractures and subsequent nonunions have occupied a substantial portion of the orthopaedic literature. The authors examine the role of modern diagnostic tools in making an earlier diagnosis of scaphoid nonunion, in more accurately determining the displacement and angulation of the fragments, and in identifying the presence of avascular necrosis. They...

conclusions a clinical examination combined with a plain radiograph should be considered to improve the diagnostic precision for patients presenting with scaphoid fractures in an emergency department. in this way, both overtreatment and undertreatment of patients can be avoided. results scaphoid tubercle tenderness had a sensitivity of 95.23% and a specificity of 74.07% in the diagnosis of scap...

Injuries to the wrist often present problems of accurate diagnosis and effective treatment (MacAusland 1944, B#{246}hler1956, Cave 1958, Aitken and Nalebuff 1960). Those associated with fractures are usually demonstrated by proper radiographs, but even these injuries may be missed (Soto-Hall and Haldeman 1941, Speed 1950). Dislocation of the scaphoid bone may occur after apparently successful r...

AIMS To compare complications associated with dorsal percutaneous and limited dorsal approaches in the surgical treatment of fractured scaphoid bone. METHODS A total of 51 patients with acute type A2, B2 and B3 scaphoid fractures were treated by limited dorsal approach. During follow-up examinations we analysed the functional outcome and per- and post-operative complications, and we compared ...

Diagnosis of upper extremity injuries depends on knowledge of basic anatomy and biomechanics of the hand and wrist. The wrist is composed of two rows of carpal bones. Flexor and extensor tendons cross the wrist to allow function of the hand and digits. The ulnar, median, and radial nerves provide innervation of the hand and wrist. A systematic primary and secondary examination of the hand and w...

We reviewed 10 patients with symptomatic malunion of a carpal scaphoid fracture. All had displacement with dorsiflexed intercalated segment instability, and suffered from pain, restricted range of movement at the wrist and decreased grip strength. The restriction of flexion-extension and the decreased grip strength correlated with the severity of the DISI deformity. Seven patients had a correct...