(Solution Document) Case Study Case Study: Sandi Elgin, a 21-year-old French literature major, was p

Case Study

Case Study:

Sandi Elgin, a 21-year-old French literature major, was playing racquetball when she tripped over the foot of her opponent and fell to the floor. Breaking her fall with her outstretched right hand, she immediately experienced sharp pain in her right wrist. She ended the game and went back to her residence hall room. She told her roommate that she thought she had sprained her wrist. Her roommate told her to take some Advil and got her some ice for her wrist. The Advil and ice were somewhat effective at easing the pain; however, by evening she noticed some swelling in her wrist and bruising at the base of her right thumb. Moving either her thumb or her wrist caused pain, as did grasping her tea cup. It was just as bad the next morning, so she went to the student health center.

Examination at the health center revealed minimal swelling and ecchymosis on the lateral side of the wrist in the region just proximal to the thumb. When asked to rate her pain on a scale of 1 to 10 (with 10 being the worst), she first said ?7?, thought for a moment then said ?well, maybe 6, no, call it a 5?. The intern then performed three manipulations on Sandi. First, he pressed at the base of her anatomical snuffbox (she said ?wow, that is a 7 or an 8 for sure?). Second, pain was also elicited when the intern extended Sandi?s wrist with one hand and pressed with the other hand on the lateral side of the wrist. Third, compressing the phalanx of the thumb longitudinally along the long axis of the first metacarpal (i.e. holding the base of the thumb and pushing it toward the wrist) also caused pain. Following the examination, the intern sent Sandi to the hospital for radiography of her wrist and referred her to an orthopedic surgeon.

After examining the X-rays, the radiologist reported that no fracture could be seen in the wrist, hand or forearm. Based on the results of the initial examination, the radiologist?s report, and her own subsequent examination, the orthopedic surgeon made a tentative diagnosis of a fracture of the scaphoid bone.

Based on this presumptive diagnosis, a short arm thumb spica cast was applied to keep the wrist in radial deviation and 10 degrees of flexion. The forearm, wrist, and thumb were included in the cast, while the fingers remained mobile. Sandi was sent home with a prescription for Tylenol #3 and instructions to whenever possible, keep her right hand elevated at or above the level of her heart to reduce edema. She was scheduled for another set of X-rays in two weeks.

The second set of X-rays, shot 2 weeks later, showed clear evidence of a nondisplaced fracture in the middle section of the scaphoid. Sandi was told everything looked good and to come back in 10 weeks. Ten weeks later she returned for another set of X-rays that showed the fracture was well healed. The cast was removed and Sandi was referred to physical therapy to restore mobility of the thumb and wrist.


2. Scaphoid fractures most commonly occur in young adults, while similar falls in children and older adults most commonly result in distal radial fractures (also called Colles? fractures). Explain why this difference occurs.


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