20231110 Wrist disorders p2b - Dr Dominic

30 year old gentleman fell on his outstretched left hand 6 months ago and had radial-sided wrist pain since then. Xray done immediately post trauma was told to have no fracture seen. The pain is affecting his work as a courier man. There is mild swelling at the dorsoradial aspect of the wrist upon examination. What imaging modality would you order for him?

• Wrist xray AP and lateral view

• Scaphoid series xray

• CT scan of the wrist

• MRI of the wrist

• No need imaging

The radiograph done is as shown above. What is the most appropriate treatment at this point?

• Wrist arthroscope to assess the intercarpal ligaments

• Proximal row carpectomy

• Open reduction, internal fixation and autologous bone grafting

• 4 corner fusion

• Thumb spica cast

A 40 year old gentleman had a closed fracture of the proximal pole of right scaphoid after a fall. Radiograph showed fracture displacement of 2mm. He is a smoker and refused surgery. What is the most likely sequelae that will develop first?

• Scapholunate advanced collapse (SLAC)

• Scaphoid non-union

• Osteoarthritis of radiocarpal join

• Scaphoid nonunion advanced collapse (SNAC)

• Wrist instability

Based on the natural history of the sequelae, what is most likely to occur next if left untreated?

• Osteonecrosis of the adjacent carpal bone

• Radioscaphoid arthritis

• Midcarpal arthritis

• Pancarpal arthritis

• Wrist deformity

The following are patient parameters to consider in scaphoid nonunion, except

• Age

• Activity level

• Circulation and perfusion of the involved limb

• Amount of pain/ dysfunction

• Length of time the nonunion has been present