This is EM cases, EM Quick Hits podcast, where our team of experts and educators bringing clear, concise, and condensed, practice-changing knowledge on all those EM topics you may not be totally comfortable with.

Cases, the latest evidence, procedural tips and tricks, pitfalls to avoid, and the key take-home points and references on the EMCases website.

Quick, let's get on with it.

EM cases is part of Shremi, the Schwartz-Risman Emergency Medicine Institute.

That's the nonprofit organization dedicated to improving EM care through high-quality research and education. The opinions expressed on this podcast are intended for general information and educational purposes only and should not be used to diagnose treat or prevent any medical condition, nor should they be used as a substitute for medical advice from qualified practicing physician. Unless stated otherwise, the opinions expressed by the hosts or guests are made in their individual capacity, not on behalf of the Institute nor Medicine cases. First up, we have the master of ED Ortho, Aaron Ciel, who's going to talk to us about

scapefoid fractures. Now, we all know the basics of scafoid fractures, but there's some nuances

in assessment that he's going to outline for us, like understanding age and gender-related prevalence,

the value of the three simple physical exam maneuvers, and when to

order scafoid views. Take it away, Dr. C.L. For this episode of EM Ortho-Quick hits,

we're going to talk about scafoid injuries, and I'll readily admit that before working in the

fracture clinic, my ED approach was oversimplified. It's a problem fracture.

I knew that was at risk for healing with non-union AVN. I knew X-rays could miss up to 30% of scapeoid fractures. So I'd check the snuff box and if they were tender, add a scapeoid x-ray. If the x-rays were negative, we diagnosed a clinical scapegoat fracture, immobilized, and arrange follow-up. There are a number of assessment pearls I've learned from the orthopedic surgeons and from working

in the fracture clinic the last number of years that help me on my emerge shifts now, and I hope

they'll be helpful to you as well. So first off, it's important to understand age-related prevalence

of these injuries. By the numbers, distal radius versus carpal fractures, if a patient

has a wrist injury and emerge, distal radius fracture is far more common, likely 80%. Carpals are around 20%.

And of all those carpal fractures, right, which represent only 20% of wrist injuries, scafoid is about 70%.

So it's not all of them are scafoytes.

So on subsequent quick hits, we'll cover some of the important carpal injuries that are not

scaphoid fractures.

But for this episode, we'll focus on the scafoid, and you should appreciate it as well

that scaphoid fractures are not equally common in all age groups.

...