Emergency Department Evaluation and Treatment of Wrist Injuries

A New Mechanism of Injury for Scaphoid Fractures: ‘Test Your Strength’ Punch-Bag Machines

“…However, only 23% of scaphoid fractures occur at work, with the rest occurring during sports (26%), leisure time (27%) and in road traffic accidents (24%) (Van der Molen et al, 1999). The most common mechanism of scaphoid fracture is hyperextension of the wrist (Ritchie and Munter, 1999), usually due to a fall on the outstretched hand (Yin et al, 2007). Less common mechanisms of injury include forced palmar flexion of the wrist (Ritchie and Munter, 1999), and axial loading of the wrist with the wrist in a flexed position, as occurs when punching (Horii et al, 1994).…”

“…The most common mechanism of scaphoid fracture is hyperextension of the wrist (Ritchie and Munter, 1999), usually due to a fall on the outstretched hand (Yin et al, 2007). Less common mechanisms of injury include forced palmar flexion of the wrist (Ritchie and Munter, 1999), and axial loading of the wrist with the wrist in a flexed position, as occurs when punching (Horii et al, 1994). Other unusual mechanisms of injury include the application of rigid handcuffs (Ball et al, 2008), and playing a 'smash' shot in a game of badminton (Brutus and Chahidi, 2004).…”

Imaging of Athletic Wrist and Hand Injuries

“…In such cases, specialized clench fist 6 and ulnar deviation studies are needed to augment standard views. 2,7 Initial radiographs may be negative for the detection of nondisplaced scaphoid fractures. 1 For this reason, continued immobilization of the athlete with snuffbox tenderness is recommended until a fracture can be documented or until pain resolves.…”

“…Earlier diagnosis of carpal fractures may be required in the athlete, and magnetic resonance imaging (MRI), bone scan, or computed tomography may be of aid. 1,[7][8][9] MRI examination will reveal a low signal fracture line with prominent subjacent marrow edema. Alternatively if no scaphoid fracture is found, MRI may find other causes for pain that simulate a scaphoid fracture, including bone contusions, fractures of other carpal bones, or soft-tissue injury (Fig.…”

“…The cortical ring sign occurs due to abnormal orientation of the scaphoid with the scaphoid being rotated and appearing foreshortened on the AP radiograph. 7,34 The scapholunate ligament has three components: volar, central, and dorsal. These three components have different histologic properties and biomechanical functions.…”