Page 65 - Demo

MCQ 2: Wrist InjuryScenario:A 25-year-old man presents to A&E after falling on his outstretched handwhile skateboarding. He complains of pain in the wrist, particularly whenmoving his thumb. On examination, there is tenderness in the anatomical snuffbox. Initial X-rays appear normal. What is the most appropriate next step in management?A. Discharge with analgesia and advice to return if symptoms persistB. Apply a short arm cast and review in 1 weekC. Arrange for an immediate MRI scanD. Apply a thumb spica cast and arrange follow-up X-ray in 10-14 daysE. Refer for immediate orthopaedic consultationAnswer:%u2022 Apply a thumb spica cast and arrange follow-up X-ray in 10-14 daysExplanation:This scenario is highly suggestive of a scaphoid fracture, even though initial X-rays are normal. Due to the high risk ofcomplications (like avascular necrosis) if a scaphoid fracture is missed, the appropriate management is to treat as ifthere is a fracture. This involves applying a thumb spica cast and arranging a follow-up X-ray in 10-14 days, when afracture line may become visible if present.