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著者:Katherine Dolbec and Joe Ravera
 
Abstract
Scaphoid fractures are commonly missed in the acute setting. This is both because physical examination findings are not dramatic and because initial radiographs are frequently falsely negative soon after this injury. The clinician should maintain a high index of suspicion for this injury. Consider advanced imaging if x-rays are negative but clinical suspicion remains high. Treatment is with splinting, over-the-counter analgesics, and close outpatient orthopedic follow-up.
 
Keywords
anatomic snuff box tenderness
anatomic snuffbox
fall on outstretched hand
fat stripe
FOOSH
FOOSH injury
navicular fracture
nonunion
osteonecrosis
perilunate disloation
scaphoid compression test
scaphoid fracture
scaphoid tubercle tenderness
wrist fracture
wrist injury
wrist pain
wrist swelling

Presentation  
    The patient (usually 14–40 years of age) fell on an outstretched hand (FOOSH) with the wrist held rigid and extended and now complains of decreased range of motion (ROM) and a deep full pain in the wrist, particularly on the dorsal radial side. Physical examination discloses no deformity or ecchymosis but shows pain with motion and palpation and often swelling. Swelling may be seen, especially in the anatomic snuff box, the hollow seen on the radial aspect of the wrist when the thumb is in full extension (between the tendon of the extensor pollicis longus and the tendons of the abductor pollicis longus and extensor pollicis brevis) (Fig. 127.1). The pain, which may be mild, is worsened by gripping or squeezing.
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