Diagnostic Studies

Initial radiographs included three standard films of the wrist: a posteroanterior (PA) view of the wrist with the forearm in a neutral position, a lateral projection of the wrist, and an oblique view with the forearm in 35 degrees of supination. These films were negative. Follow-up serial films at 4 weeks demonstrated a fracture of the proximal pole of the scaphoid (Fig. 57-1).

Proximal Pole Scaphoid Fracture
Figure 57—1. Posteroranterior view of the hand showing acute proximalpole scaphoid fracture.
Radial Wrist Pain Differential Diagnosis
Figure 57—2. Evaluation of acute radial-sided wrist pain.

The diagnosis of scaphoid fracture is often not straightforward. We have developed an algorithm for the radiographic evaluation of radial wrist pain (Fig. 57-2). Initial evaluation includes the standard set of radiographs. Follow-up of initial studies is demanded for persistent pain. Resorption of bone at follow-up will aid in fracture detection. A bone scan taken 2 to 3 weeks after injury is highly sensitive for fracture or ligamentous injury. A negative scan excludes a fracture. Computed tomography (CT) and magnetic resonance imaging (MRI) are highly specific and sensitive for detection of a scaphoid fracture.

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Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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