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).
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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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.