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.
You are to demonstrate to the junior doctor how to apply a scaphoid backslab.
You have never done a scaphoid backslab before and want to watch this one being done. You can assist as directed.
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.
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.
- Ensure adequate analgesia
- Note use of thumb spica not supported by some literature over Colles' cast
- Early MRI for return to work