0:00

So this is a person who fell on outstretched hand

0:04

and presents with snuff box tenderness.

0:07

Here we have three projections of the wrist, our frontal,

0:11

lateral, and oblique,

0:13

and we wanna look along the distal contour of the radius

0:17

to see that that's maintained.

0:19

The ulnar is intact, ulnar YL is maintained, distill radial,

0:24

ulnar joint carpal arcs.

0:27

And because of the snuff box tenderness,

0:29

we'll pay particular attention to the scaphoid.

0:32

So on the projection here,

0:34

sometimes the patient is placed in radial deviation,

0:36

which can force shorten the scaphoid.

0:38

So we look at our oblique.

0:41

And on the oblique, it appears

0:43

that there may be a step off near the waist

0:45

of the scaphoid here.

0:48

Lateral projection shows our normal relationship distal

0:52

radius ulna capitate third metacarpal, given

0:56

that the wrist has a little bit of extension.

1:00

So if you were suspicious for a possible scaphoid fracture,

1:03

something that you could obtain while you're still

1:06

performing radiography in the emergency department is

1:09

to do a scaphoid view.

1:11

And so with our scaphoid projection here, we now outline

1:15

that the scaphoid and makes the scaphoid waist fracture

1:20

much more conspicuous.

1:22

So diagnosis here is a non-displaced

1:25

scaphoid waist fracture.

1:27

Let's look at another patient comes in with a similar story.

1:30

So here we have three projections of the wrist

1:33

that we're gonna scroll through.

1:35

So here's our frontal oblique and lateral.

1:39

So if we look at our lateral projection, distal radius, ulna

1:44

capitate, all pretty much line up again given the amount

1:48

of slight palmar tilt of the wrist.

1:51

If we come back to our frontal projection,

1:54

not optimally positioned,

1:56

however, we can see that the ulnar variance is maintained,

2:00

carpal arc is preserved.

2:03

And if we go to our oblique projection

2:06

and we look at the contour of the scaphoid, we can identify

2:09

that the waste appears intact.

2:12

But we have this lucency through the distal portion

2:15

of the scaphoid, which is known as the scaphoid tubercle.

2:18

And so this represents a non-displaced scaphoid tubercle

2:22

fracture.

Case: Scaphoid Waist Fracture

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