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Old 10-31-2011
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Rheumatology/Orthopedics Tender Anatomic Snuff Box

a 35 yr old man falls on his hand and comes to the urgent care clinic complaining of wrist pain. he relates that he was not able to break the fall, and that the heel of his hand took the brunt of his full weight as it hit the pavement. on physical exam, tenderness over anatomic snuff box. Anteroposterior and lateral xray films are negative. which of the following is the most likely diagnosis an appropriate next step in management?

a. scaphoid bone fracture; thumb spica cast
b. de quervain tenosynovitis; steroid injections
c. displaced scaphoid fracture; open reduction and internal fixation
d. ligaments injury; ace bandage and analgesics
e. no fracture; reassurance
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Old 10-31-2011
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The correct answer is A non displaced scaphoid bone fracture and you treat it with thumb spica cast.
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Old 10-31-2011
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A.scaphoid #


tenderness on anatomic snuff box gives it away
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A? scaphoid fracture thumb spica cast
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Default yes answer is A

nondisplaced fractures of the carpal navicular (scaphoid bone) are notorious for not showing up on xray films at the time of injury. the mechanism of injury and findings in this vignette is enough to make presumptive diagnosis and indicate use of cast.
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