Clinical Assessment of Scaphoid Injuries and the Detection of Fractures

Difficulty in interpreting X-rays following carpal injury emphasizes the importance of clinical assessment in diagnosing scaphoid fractures. The classical sign of tenderness in the anatomical snuffbox is not specific and leads to many unnecessary out-patient reviews. A prospective comparison was made between anatomical snuffbox, scaphoid tubercle and scaphoid compression tenderness as indicators of scaphoid fracture in 221 patients with suspected scaphoid injury. Swelling was determined by measuring the difference in circumference at the wrist joint to compare between fracture and soft tissue injury. Scaphoid compression tenderness was found to be the most accurate test with a sensitivity of 100% and a specificity of 80%. Swelling of the wrist joint was significantly greater when there was a fracture, compared to soft tissue injury alone, even when the initial X-ray was normal. This was independent of any physiological variation in circumference between dominant and non-dominant sides. Scaphoid compression tenderness is therefore suggested as the most accurate indicator of scaphoid fracture and marked swelling should raise suspicion even if the X-ray is normal.

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Os Centrale Carpi Simulating a Scaphoid Waist Fracture

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(94)90252-6 ◽

1994 ◽

Vol 19 (6) ◽

pp. 754-756 ◽

Cited By ~ 7

Author(s):

Z. Y. YANG ◽

L. A. GILULA ◽

K. JONSSON

Keyword(s):

Soft Tissue ◽

Sagittal Plane ◽

Tissue Injury ◽

Incidental Finding ◽

Scaphoid Fracture ◽

Soft Tissue Injury ◽

Carpal Bone ◽

X Ray

The os centrale carpi is a relatively rare accessory carpal bone, and its presence may be confused with a scaphoid fracture. A case is presented which simulated an un-united scaphoid fracture on the plain X-ray film. However, CT in the sagittal plane showed two rounded fragments on the dorsum of the scaphoid with smooth, regular cortical margins differing from an acute scaphoid fracture. Their volume combined with the volume of the scaphoid is more than that of a completely normal scaphoid. There is no evidence of degeneration in the two rounded fragments and scaphoid. Because of these features, the diagnosis of soft tissue injury with an incidental finding of an os centrale carpi was suggested.

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An Overview of Facial and Head and Neck Trauma at Patan Hospital

Nepalese Journal of ENT Head and Neck Surgery ◽

10.3126/njenthns.v6i1.19437 ◽

2018 ◽

Vol 6 (1) ◽

pp. 15-19

Author(s):

Namita Shrestha ◽

Bhawana Dangol ◽

Ishwor Raj Devkota ◽

Ajit Nepal ◽

Deepak Yadav ◽

...

Keyword(s):

Soft Tissue ◽

Oral Cavity ◽

Head And Neck ◽

Tissue Injury ◽

Soft Tissue Injury ◽

X Rays ◽

Neck Trauma ◽

Facial Soft Tissue ◽

Common Mode ◽

Head And Neck Trauma

Objective: To find out the prevalence of various types of head and neck trauma.Material and Methods: This retrospective study was done in the department of ENT and HNS, Patan Hospital, PAHS. Charts were retrospectively reviewed for total 61 inpatients with a diagnosis suggestive of head and neck trauma from August 2013 to January 2015. Data was collected for age, sex, address, type of admission (emergency/OPD), mechanism of injury, site of injury , imaging including X-rays/CT scan wherever applicable and results, surgical therapy, type of anesthesia, hospital admission duration, complications, and follow-up and analyzed.Result: Males were common than females (62.3% vs. 37.7%). Fall was the most common mode of injury (100%) in both pediatric and elderly population and in adults RTA (42.10%) was the most common mode. In the type of injury most common in pediatrics was oral cavity and oropharyngeal injury (47.60%), in adults facial soft tissue injury (STI) and facial fractures (42.10%) were equally common and in geriatrics it was (100%).Conclusion: Adult males were prone to head and neck trauma mostly sustaining soft tissue injury (STI) and fractures due to RTA and physical assult. Injury to oral cavity and oropharynx and STI due to fall is common in extreme of ages. Though the management out comes were good and no grave complications were reported in this study.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

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Clinical diagnosis of clavicle fractures: a pilot study

CJEM ◽

10.1017/s1481803500005315 ◽

2001 ◽

Vol 3 (02) ◽

pp. 95-98 ◽

Cited By ~ 2

Author(s):

Jim Landine ◽

Robert McGraw ◽

William Pickett

Keyword(s):

Pilot Study ◽

Tissue Injury ◽

Clavicle Fracture ◽

Soft Tissue Injury ◽

X Rays ◽

Future Studies ◽

X Ray ◽

Clavicle Fractures ◽

High Degree ◽

Diagnostic Radiography

ABSTRACTObjective:Clavicle fractures are commonly encountered in the emergency department (ED). Our objective was to determine whether emergency physicians can clinically predict the presence and location of a clavicle fracture prior to obtaining x-rays.Methods:Over a 16-month period we prospectively studied ED patients who had injuries compatible with a clavicle fracture. Following clinical examination and prior to obtaining radiographs, ED physicians or senior emergency medicine (EM) residents were asked to predict whether the clavicle was fractured and, if fractured, the location of the fracture. Clinical predictions were later compared to the radiologist’s report.Results:Between April 1999 and August 2000, 184 patients with possible clavicle fracture were seen and 106 (58%) were enrolled. Of these, 94 had an acute fracture, and all 94 fractures were predicted on clinical grounds prior to x-ray. In 6 cases, physicians predicted a fracture but the radiograph was negative. In 6 additional cases, physicians were clinically unsure and the radiograph was negative. Physicians correctly predicted fracture location in 83 of 94 cases (88%; 95% confidence interval [CI], 82%–95%). In the 64 cases where physicians predicted a middle third fracture, they were 100% accurate (95% CI, 95%–100%). Errors made by physicians were conservative; that is, they occasionally predicted fractures in patients with only soft tissue injury, but they did not “miss” existing fractures.Conclusions:The results of this pilot study suggest that ED physicians can clinically predict the presence and location of clavicle fractures with a high degree of accuracy. It may be that x-rays are not always necessary in patients suspected of having a clavicle fracture. Future studies should define the indications for diagnostic radiography in patients with suspected clavicle fractures.

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X-Ray Diagnosis of Acute Scaphoid Fractures

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2005.09.001 ◽

2006 ◽

Vol 31 (1) ◽

pp. 104-109 ◽

Cited By ~ 24

Author(s):

G. C. CHEUNG ◽

C. J. LEVER ◽

A. D. MORRIS

Keyword(s):

Retrospective Review ◽

Scaphoid Fracture ◽

Initial Presentation ◽

Alternative View ◽

X Rays ◽

X Ray ◽

Scaphoid Fractures ◽

Suspected Scaphoid Fracture

In a retrospective review of the radiographs taken for 113 acute scaphoid fractures, each view was assessed for the clarity of demonstration of the fracture. The X-rays on which diagnosis of fracture were made, were taken between 0 and 16 days after injury (mean, 2 days). Whenever a lateral, supinated oblique or elongated view was taken, the fracture was always seen clearly on an alternative view. We recommend the use of four views at initial presentation of suspected scaphoid fracture: PA and lateral to assess carpal alignment, with pronated oblique and ulnar deviated PA to detect the fracture.

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Management of Acute Soft Tissue Injuries

Journal of Pharmacy Practice ◽

10.1177/0897190002239634 ◽

2003 ◽

Vol 16 (1) ◽

pp. 51-58 ◽

Cited By ~ 7

Author(s):

Nayahmka McGriff-Lee

Keyword(s):

Soft Tissue ◽

Soft Tissues ◽

Tissue Injury ◽

Wrist Joint ◽

Soft Tissue Injury ◽

Soft Tissue Injuries ◽

Pharmacological Therapy ◽

Acute Injury ◽

Appropriate Treatment ◽

Inflammatory Drugs

Participation in sports-related activities increases the risk for acute injury to soft tissues. In adults, the sites most often affected include the ankle, knee, and wrist joint structures, along with the muscles of the back and extremities. The subsequent inflammatory response to tissue damage results in pain and swelling, which limits mobility. A thorough patient assessment is required for accurate diagnosis and provides a guide for appropriate treatment. Initial management is based on the principles of basic first aid: rest, ice, compression, and elevation. Pharmacological therapy can also be used to achieve pain relief and improve mobility. There are few well-controlled studies addressing the pharmacotherapy of acute soft tissue injury, but clinical experience with nonsteroidal anti-inflammatory drugs is extensive. Both traditional and nontraditional therapeutic approaches are discussed.

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Scaphoid Fractures and Nonunions: A Comparison between Panoramic Radiography and Plain X-Rays

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(98)80051-x ◽

1998 ◽

Vol 23 (3) ◽

pp. 328-331 ◽

Cited By ~ 11

Author(s):

J. D. BERNÁ ◽

F. ABALEDEJO ◽

M. A. SANCHEZ-CAÑIZARES ◽

G. CHAVARRIA ◽

A. PARDO ◽

...

Keyword(s):

Panoramic Radiography ◽

Scaphoid Fracture ◽

X Rays ◽

X Ray ◽

Scaphoid Fractures ◽

Diagnostic Potential ◽

Panoramic Images

This study describes the diagnostic potential of the panoramic X-ray technique in the evaluation of scaphoid fractures and nonunions. Fifty-eight symptomatic wrists were examined using both plain X-rays and the panoramic procedure. The panoramic images showed in detail the line of the scaphoid fracture and nonunion in detail; they revealed four scaphoid fractures and five nonunions that were not shown clearly with plain X-rays. The panoramic technique is a useful complement to plain X-rays for the investigation of scaphoid fractures and nonunions.

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