Trauma and Post-OP Management: Scenario 4

00:01 Okay, two more scenarios.

00:02 This is quite common.

00:04 That's why I'm putting a couple more scenarios, scaphoid views.

00:07 Sorry, scaphoid fracture.

00:13 You got the scenario so far.

00:14 Yeah, so that's what you see.

00:21 Yeah.

00:24 Management of scaphoid fractures.

00:30 No, no.

00:32 Just get the management.

00:35 You don't have any imaging.

00:36 Just EMQs and syllabus sensus.

00:39 Okay? How do you manage scaphoid fractures? Clinically suspected scaphoid fracture, x-ray.

00:57 If there is no scale, if you don't see a fracture.

01:05 For how long? Yeah, but...

01:12 two weeks.

01:13 Yeah.

01:13 Okay.

01:14 So, what you said was right for a diagnosed scaphoid fracture, but if you just suspected, it is officially investigate with scaphoid views, then...

01:26 if it is ambiguous, MRI plus or minus bone scintigraphy, high-spatial-resolution ultrasound is useful, if you can't get an MRI, done in time.

01:39 Management will be clinical suspicious but normal x-ray.

01:43 Then, short arm's spica for two weeks, re X-ray, and then the X-ray is normal, no further treatment is required.

01:51 The fracture is seen, then you have to go for scaphoid cast for 4-6 weeks.

01:59 Okay.

02:00 And re-xray and manage depending on the healing.

02:03 Okay.

02:03 Because scaphoid fracture is quite common, so they will expect you know what do you do if you don't see a fracture in the X-ray.

02:12 Okay, that is only if you have displaced fragment, you do a Herbert screw fixation like that, that screw.

02:20 Select crew for fixing a scaphoid.

02:24 Okay, final scenario.

02:28 What's this? No, fracture in a femur, you can see, is the intracapsular or extracapsular? Intracapsular.

02:38 So, clinical features they will give you patient's press elderly patient, shortened externally rotated leg.

02:47 Diagnosis, scaphoid. Sorry, fracture neck of femur Then they may give a couple of scenarios but what they're really looking for in that is fractured neck of femur, do you know the difference between intracapsular and extracapsular? And do you know, how do you manage the different fractures? Who's confident of answering that? Go on.

03:09 Go on.

03:39 Sorry, in that can you treat intracapsular conservatively? What's indication? When do you treat conservatively? Yes or one more? Gardens to bond with undisplaced.

03:56 Undisplaced.

03:57 So you don't have to, you don't have to fix it.

04:01 Yeah.

04:01 Okay.

04:02 Would you always go for hemiarthroplasty for a intracapsular fractures? How do you preserve it? Not an IVUS screws, cannulated screws.

04:17 Okay.

04:19 Okay, so what about for extracapsular? Subcontracture.

04:45 Okay.

04:46 Now, you need to be very clear because you will make this section on management of fracture neck of femur.

04:53 So, classification need to know, this is intracapsular/extracapsular.

04:57 That is at the risk of avascular necrosis.

04:59 This does not have a risk to have avascular necrosis.

05:03 That's the blood supply.

05:04 You may be asked in the single best answer about the blood supply to the neck of femur.

05:12 Predominately, it comes from the femoral artery, by the circumflex femoral vessels.

05:17 But you also get it from the epiphyseal artery, and the ligamentum teres coming to the head, but this is a crucial point.

05:24 Okay?