Saturday, March 08, 2003

what an end to that troubled week for the boy and me:

evan fractured his wrist on thursday while playing netball.martyr that he is, he played the entire game after his fall ("can't leave the team alone!"), and idiots they are, the other doctors on the team deemed his injury "harmless" - while fiona the physio (you know, the one who wants to get inside his pants) thought he should go to the ed immediately.
unfortunately, he didn't though, but instead suffered all night until he dragged himself there early friday.

of course, as usual, when evan does something, he does it right: he got himself a distal third scaphoid fracture on his left hand.

fracture of the wrist sounds quite harmless - unfortunately though, that scaphoid fracture can apparently be a meanie. not only will the boy be in a cast for at least 6 weeks (no working out, no driving, being unable to put lines into patients, being unable to do full examinations, no use of left hand, typing discharge summaries with one hand etc.), this thing can have serious consequences if it doesn't heal well.

let me quote from the bones home page: the interactive hand
scaphoid fractures

"scaphoid fractures are known to have unpredictable healing.
this is due to the unique anatomy of the scaphoid itself. the fracture itself often cuts off normal blood circulation to pieces of the bone. also, other wrist bones attached to each end of the scaphoid move broken pieces away from each other - so strongly that it may not be possible to hold them together with any type of cast.

for this reason, these fractures may heal slowly (delayed union) or not at all (nonunion). also, if circulation to part of the bone is cut off and not recovered, that part of the bone will deteriorate (avascular necrosis) and lead to degenerative arthritis.


conservative treatment involves prolonged immobilization for as many months as the fracture takes to heal. because some fractures will fail to heal despite casting for a year or more, surgery may be needed to hold the bone pieces in place. surgery to promote healing is most often recommended for displaced fractures and those which have failed to heal despite casting. this involves special hardware and possibly a bone graft. this type of surgery is not always technically possible. degenerative arthritis is a definite possibility with these injuries and may require future reconstructive surgery.
exercise and therapy is recommended after the fracture heals.
(now, do is see someone already queing up to take position as his personal physio?) other problems include weakness, persistent soreness, visible deformity, reflex sympathetic dystrophy and other possible problems. stiffness after a scaphoid fracture is almost always seen."

trouble with a hand is one of the worst things to happen to a doctor, really. it's not like evan was ever planning to become a surgeon, but you need a well functioning hand as a doc, period.

thankfully, after the folks in ed had stopped laughing when he turned up yesterday morning, they referred him straight to the top ortho folks at the hospital, and evan got first class (free) treatment, including an mri, and a cast by the ortho surg registrar (who's usually above these duties). nice. they were considering surgery but for now chose the cast. i am not sure why they considered surgery - need to ask him whether his fracture is actually displaced or not. hm.
i swear, i learned more about anatomy of the hand and fractures and treatment in the past hour than i ever thought i'd ever need. blessed be the internet.

i'm a bit worried whether he will actually rest the hand as much as he has to and get through the day okay. apparently, the flatmates have been helpful so far, but will they do that for a full six weeks? will he have to change rotations? he's supposed to be on ed in three weeks, but would be most useless there with just one hand. he's also supposed to be on his country rotation in five weeks. will he have to go there, unable to drive himself?

i wish i could fly over and be there for the boy. however, unless he gets surgery, it doesn't really make much sense. - i offered it, we discussed it, but i couldn't be there for the whole time he heals so what use would i be?

he's just such a bad patient, the boy.- not just because he is a bloke and a doc. he can't rest, he gets restless when he can't work out, he pushes himself when he really shouldn't. and yeah, knowing about the risks involved with his type of fracture, he's in quite a foul mood, too.

argh. argh. argh. i so hate the limitations of ldrs in situations like these.

it's time for a care package.

scaphoid fractures: frequently asked questions
the scaphoid fracture page
hand university - a patient's guide to scaphoid fractures