Scaphoid fractures and wrist pain--time for new thinking

As with the practice of all medicine, an early accurate diagnosis is essential. The same applies after injury. The diagnosis should be made at the earliest opportunity--this should be done as soon as an appropriate expert is able to examine the patient, assess adequate radiographs and, where necessary, order special investigations such as a bone scan. By this means, distal radial fractures, injuries of the radioulna joint, dislocated lunates, Bennett's fractures, dorsal capsular wrist sprains, avulsion fractures etc. can be managed accordingly. Those patients in whom clinical examination, plain radiographs and/or bone scans show minor injuries can be advised about pain relief whilst staying active either at work or in the home using a light supportive removable bandage or splint. Where doubt remains and whilst keeping the patient comfortable, a bone scan may be requested. Its availability together with updated clinical and, if necessary, radiological assessment, will define a further group of patients who can be advised definitively either about active treatment or a return to normal activity. Only a few wrists will continue to defy definitive diagnosis requiring the continuance of expert advice and investigation. When a scaphoid fracture is diagnosed, its site, degree of displacement and any associated instability should determine the degree of intervention and the length of time required in plaster. This again gives the patient more information about the long-term future than many have had hitherto. The patient's individual requirements may be taken into account; some are happy to tolerate 2-3 months in plaster whilst others want the early function which an uncomplicated operation might offer.(ABSTRACT TRUNCATED AT 250 WORDS)