The Skeptics Guide to Emergency Medicine SGEM#475: Break on Through to the Other Side – Management of Clinical Scaphoid Fractures
May 17, 2025
Dr. Matt Schmitz, an orthopedic surgeon specializing in adolescent sports medicine, shares insights on the management of scaphoid fractures. He discusses a clinical study showing that short-term bandaging can match traditional casting in effectiveness, challenging long-held practices. The conversation delves into biases in clinical trials and the importance of proper masking. Schmitz advocates for a more patient-centered approach, emphasizing selective immobilization for low-risk cases and the complexities of follow-up in treatment outcomes.
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Orthopedic Surgery Evidence Skepticism
- Matt Schmitz shared his experience facing skepticism from orthopedic colleagues due to low evidence for common surgeries.
- Despite criticism, he advocates always seeking better research and answers.
Exam Limits for Scaphoid Fractures
- No single physical exam can reliably rule in or out an occult scaphoid fracture after a FOOSH injury.
- Clinical judgment remains challenging despite common suspicion signs like anatomical snuff box tenderness.
Overtreatment of Suspected Scaphoid Fractures
- Overtreatment occurs due to routine casting when initial X-rays are normal but suspicion remains.
- Only 10 to 20% with suspected scaphoid fractures on exam have confirmed fractures on follow-up imaging.