Der Unfallchirurg
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Scaphoid fractures are frequent but are overlooked in 20-40% of cases on initial radiographs. In so-called occult scaphoid fractures, i.e. clinical scaphoid fractures with negative X‑ray diagnostics, the hand of the patient is often empirically immobilized with a cast and the X‑ray diagnostics repeated 10 days later. ⋯ Pensioners and patients with low manual demands, however, can be treated according to the traditional algorithm. Additional use of computed tomography (CT) or magnetic resonance imaging (MRI) diagnostics with or without intra-articular contrast agent might be helpful if concomitant soft tissue injuries are suspected.
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Patients must be informed of the chances of success and risks well in advance of the intended treatment measure so that they can adequately maintain a freedom of choice and thus the right to self-determination by carefully considering the reasons for and against the recommended measure. Fixed deadlines for the time between information and consent cannot be set as a blanket measure. ⋯ If this period of deliberation is not granted and consent is requested immediately, the doctor must convince himself before the treatment measure is carried out that the consent given still corresponds to the patient's will. This request is not necessary if the patient has expressly waived a period of reflection after receiving appropriate clarification.
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The current boom in recreational sports leads to an increase in the number of long-distance runners. In addition to typical disease patterns (e.g. of the Achilles tendon) stress fractures are seen more and more frequently. ⋯ Atypical and protracted complaints therefore require a detailed medical history of the patient and should if in any doubt lead to radiological imaging. Once correctly diagnosed, rest from sports and sometimes semi-weightbearing or non-weightbearing is indicated to prevent the development of fracture non-union.