It's all in the wrist OSCE by Michael

 
You have 3 minutes reading time. This OSCE will run for a maximum of 7 minutes.

Scenario:

You are asked by a junior doctor to assist in application of a backslab for their patient with a suspected fractured scaphoid. The patient had a simple mechanical fall onto an outstretched hand with clinical findings suggesting a scaphoid fracture. X-rays were normal. They have been seen by the orthopaedic team who recommended backslab application and orthopaedic outpatient follow up in 2 weeks.

Instructions for the candidate

You are to demonstrate to the junior doctor how to apply a scaphoid backslab.

Domains being examined

  • Medical Expertise
  • Communication
  • Scholarship and Teaching
 
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

Junior doctor:

You have never done a scaphoid backslab before and want to watch this one being done. You can assist as directed.

Patient:

You can ask about cast care, "Can this cast get wet?" "How do I shower?", when it needs replacing.

The injury is of your dominant hand. You work in hospitality. You could also prompt for "Is there anything else I can do to avoid being in a cast for the next 2 weeks?"

Your hand has normal sensation and movement. You have tenderness over the anatomical snuffbox, anteroir scaphoid tubercle and pain on axial loading of the thumb.

For the examiner

The junior doctor should prompt to keep focus on the procedure if excessive time spent on assessment or management plan.

Similar scenarios would be valid for a Colles' cast, below-knee backslab or other simple plaster immobilisations.

Domains Assessment Objectives

Medical Expertise
Plaster application for scaphoid fracture

Communication
Clear explanation of procedure to junior doctor and patient

Scholarship and Teaching
Clear teaching method of procedure

Other Assessment Notes

Bonus points
- Ensure adequate analgesia
- Note use of thumb spica not supported by some literature over Colles' cast
- Early MRI for return to work


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