5. Primary survey
• A : Can speak, C-spine not tender, full ROM
• B : Equal breath sound both lungs, CCT -negative
• C : BP 130/80 mmHg, PR 102 bpm no active
external hemorrhage
• D : E4V5M6, Pupils 3 mm RTLBE
• E : Lt.wrist tenderness, marked swelling at dorsum
of left hand, no wound, no ecchymosis,
no deformity, 2+distal pulse, normal sensation
6. Secondary survey
• A : No drugs & food allergy
• M : No current medication
• P : Unknown underlying disease
• L : 15.00pm at that day
• E : MC ชน MC
7. Physical examination
• GA : A Thai man good consciousness
• HEENT : not pale conjunctivae, anicteric sclerae
• RS : clear, equal breath sound
• CVS : full, regular pulse, normal S1S2
• Abdomen : soft, not tender, no guarding
8. Physical examination
• Lt.wrist tenderness,
marked swelling at
dorsum of left hand,
no wound, no
deformity, no
ecchymosis, 2+distal
pulse, limit ROM due to
pain, normal sensation
14. Anatomy
• Major Blood supply
-Dorsal carpal branch
(Radial a)
• Minor Blood supply
-Superficial palmar branch
(Radial a)
15. Scaphoid Fx
• Most frequently fractured carpal bone
- 75% of carpal bone fracture
- 15% of acute wrist injuries
• Common in young adults
• Hyperextension injury ( Fall onto an outstretched
hand)
16. Physical examination
• Anatomic snuffbox tenderness
Pain may be severe when
move thumb or wrist to pinch
or grasp something
• Scaphoid tubercle tenderness
22. Non-surgical treatment
• Stable fracture
-Occult, incomplete or
nondisplaced
-Normal x-ray but high level
of suspicion (immobilize
and reevaluate in 14-21wk)
-Short arm with thumb spica
cast
Distal waist : 2-3 m
Mid waist : 3-4 m
Proximal waist : 4-5 m
26. • High energy injury with poor functional outcomes
• Commonly missed (25%)
• Mechanism
- traumatic, high energy
- occurs when wrist extended and ulnar deviated
• Presentation
- acute wrist swelling and pain
- median nerve symptoms (~25%)