UNC celebrates making it to the Sweet 16, but sophomore point guard, Kendall Marshall suffered a scaphoid fracture in his wrist.  Will he be back for the rest of the tournament?

ANATOMY

The hand and wrist are made up of 27 bones.  At the base of the hand, in the wrist, there are 8 bones.  The scaphoid bone is a wrist bone that sits at the base of the thumb.  

The scaphoid can be most easily recognized when one makes a “hitchhiker’s” sign.  At the base of the thumb, a hollow is created.  At the base of the hollow lives the scaphoid bone.

CAUSES

A fracture of the scaphoid is usually caused by a fall on an outstretched hand, with the weight focusing through the palm.  This type of injury is seen in young adults, but can really happen in any group. 

There are different types of scaphoid fractures.  Those closer to the thumb do better, as the blood supply to this part of the bone is good.  Those that are more central, or in the “waist” of the bone, or closer to the forearm may have more of a difficult time healing.  This part of the bone has a poor blood supply and the bone may not heal. 

SYMPTOMS

Individuals who break the scaphoid will have pain, swelling, loss of motion, and bruising.  Their can be pain in the “hollow” or “snuffbox”, difficulty with creating the “hitchhiker” posture,  or pain with grip.

WHEN TO SEEK MEDICAL CARE

If you suspect that you are suffering from a broken scaphoid, you should seek medical attention within a day or two of the injury.  A physical exam and x-rays are usually performed. A CT or MRI scan at times may be needed.

TREATMENT

Scaphoid fractures that are closer to the thumb may be successfully treated with a short arm cast that captures and immobilizes the thumb.  The cast is usually worn for 6 to 8 weeks.

Scaphoid fractures that are at the waist of the bone or closer to the forearm can be problematic. Although a thumb immobilized cast can lead to healing, at times, this may not be enough.  Since the blood supply to this part of the bone is poor, the bone may not heal.  For this reason, often times, a surgical procedure is recommended. 

Surgery is considered in scaphoid fractures that occur at the waist of the bone, closer to the forearm, or those fractures that have not healed.  In any of these surgical situations, a screw is placed in the bone to hold the pieces of the bone together and optimize the contact between the pieces.  A cast is still required and can be worm for 3 months or more.

OUTCOMES

Scaphoid fractures can be career ending for an athlete.  These injuries can affect grip strength and motion.  Occupational therapy is critical to regain motion and strength. 

RETURN TO ACTIVITIES

From the current reports, it is unclear if Marshall will need surgery.  It is unlikely for him to return for the rest of the tournament.

VIDEO/ANIMATIONS

Dr. P

---------------------------------------------------------------------------------

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

In the first quarter of today's game, Dallas Cowboys Quarterback, Tony Romo was knocked out of the game with a right hand injury.  He is on the sideline with a tight wrap.  Pictures show a highly swollen hand.  Will he play next week?

ANATOMY

The hand is made up of 27 bones.  In each finger there are 3 phalanges, whereas the thumb has 2.  In the palm of the hand, corresponding to each finger is a metacarpal.  In the wrist there are an additional 8 bones.  These bones work in concert to allow motion and stability to the hand. 

Michael Vick reportedly is suffering from a “hand” fracture.  It is unclear which exact bone is injured, however the fact that a CT scan is being ordered suggests that the base of one of the metacarpals, or perhaps one of the wrist bones was fractured. 

CAUSES

A fracture of the hand is usually caused by a trauma.  This can be in the form of sporting activities where something or someone crushes the hand or drops or twists on the hand. A punch, a fall on an outstretched hand, or even a gunshot can lead to a fracture of the hand. 

SYMPTOMS

Individuals who break their hand will have pain, swelling, loss of motion, and bruising. Depending on the location and position of the break, the finger may turn one way or the other when the fingers are flexed.  This is one of the reasons for surgery. 

WHEN TO SEEK MEDICAL CARE

If you suspect that you are suffering from a broken hand, you should seek medical attention within a week of the injury, A physical exam and x-rays are usually performed. A CT scan at times may be needed.

TREATMENT

Many hand fractures can be treated without surgery.  If one metacarpal is fractured, oftentimes a removable brace or splint can be worn for about 4 weeks.  If two or more metacarpals are fractured, but are located in the correct position, a short arm cast can be worn for 4 to 8 weeks. 

Surgery is considered if multiple metacarpals are broken, if the break is in the base of the metacarpal where it interacts with the wrist bones, if there is shortening of the metacarpal bone, or if one of the wrist bones is fractured.  Surgery can be as simple as the placement of 1 or 2 wires into the bone, holding it where it belongs, to placing plates and screws on the bone.  In any of these surgical situations, pressure is usually not allowed through the hand for 4 to 8 weeks.

OUTCOMES

Most athletes with a hand fracture have no long lasting issues.

RETURN TO ACTIVITIES

From the current reports, it is unclear of the nature of Romo's injury.  Given that this is his dominant, throwing hand, if a metacarpal is fractured it could be a big deal. A CT scan may be needed to evaluate the injury further.  If broken, he could be out next week.

VIDEO/ANIMATIONS

Dr. P

---------------------------------------------------------------------------------

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

The third week of the NFL continues to bring drama to the field due to injuries.  Week 2 saw Michael Vick exit the game from a concussion. Today, he left the game because of a broken right hand.  Will he play next week?

ANATOMY

The hand is made up of 27 bones.  In each finger there are 3 phalanges, whereas the thumb has 2.  In the palm of the hand, corresponding to each finger is a metacarpal.  In the wrist there are an additional 8 bones.  These bones work in concert to allow motion and stability to the hand. 

Michael Vick reportedly is suffering from a “hand” fracture.  It is unclear which exact bone is injured, however the fact that a CT scan is being ordered suggests that the base of one of the metacarpals, or perhaps one of the wrist bones was fractured. 

CAUSES

A fracture of the hand is usually caused by a trauma.  This can be in the form of sporting activities where something or someone crushes the hand or drops or twists on the hand. A punch, a fall on an outstretched hand, or even a gunshot can lead to a fracture of the hand. 

SYMPTOMS

Individuals who break their hand will have pain, swelling, loss of motion, and bruising.  Depending on the location and position of the break, the finger may turn one way or the other when the fingers are flexed.  This is one of the reasons for surgery. 

WHEN TO SEEK MEDICAL CARE

If you suspect that you are suffering from a broken hand, you should seek medical attention within a week of the injury, A physical exam and x-rays are usually performed. A CT scan at times may be needed.

TREATMENT

Many hand fractures can be treated without surgery.  If one metacarpal is fractured, oftentimes a removable brace or splint can be worn for about 4 weeks.  If two or more metacarpals are fractured, but are located in the correct position, a short arm cast can be worn for 4 to 8 weeks. 

Surgery is considered if multiple metacarpals are broken, if the break is in the base of the metacarpal where it interacts with the wrist bones, if there is shortening of the metacarpal bone, or if one of the wrist bones is fractured.  Surgery can be as simple as the placement of 1 or 2 wires into the bone, holding it where it belongs, to placing plates and screws on the bone.  In any of these surgical situations, pressure is usually not allowed through the hand for 4 to 8 weeks.

OUTCOMES

Most athletes with a hand fracture have no long lasting issues.

RETURN TO ACTIVITIES

From the current reports, it is unclear of the nature of Vick’s injury.  Given that this is his non-dominant, non-throwing hand, if a metacarpal is fractured he should be able to play next week.  A special cast may be made for him to protect the hand during play.  However, if one of his wrist bones is fractured, he could be out of action for 6-8 weeks.  The CT scan that he is scheduled to get on Monday should give us a lot of insight into the nature of his injury and the time to return to play.

VIDEO/ANIMATIONS

Dr. P

---------------------------------------------------------------------------------

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics