I was going to reply in the other thread but it got a bit long so I reckon Karlos's wrist deserves its own thread :-)
@ Karlos
By the looks of that scaphoid (if it is your wrist in your avatar), you are heading for a non-union. At my last placement I worked with one of the top guys in the world for scaphoid fractures, a guy called Nicholas Goddard. He fixes scaphoid fractures with a small screw with opposing threads to draw the two poles together. In some cases he takes some bone from the pelvis and injects it into the drilled channel to encourage bone mineralisation across the fracture. Here is how they set it up. Note the chinese finger traps (who says you can't have some pranks in the operating room):
Basically that allows a 360 degree X-ray access around the wrist. If he wants to do full motion X-ray filming he can just twirl the hand at the top. I would burn him a video CD for each case so he could collaborate with some dudes in the US about the placement of the screw. Here you can see the setup with the X-ray unit. In the inset I have magnified the image from screen A. The white arrows point to the distal and proximal ends of the scaphoid. You can see the fracture in between. The red arrow is the screw and the yellow arrow is the screwdriver.
Usually when somebody has a suspected scaphoid fracture (and the fracture cannot be seen) they re-X-ray the guy after 10 days to see if it has displaced. Some centers do macro-radiography for this (I was down in Basingstoke a few weeks ago and they were using a precision skull radiography unit for this). If the thing is displaced then they've proved the fracture and they might take steps to manipulate it in plaster and see if it unites. If the displacement is marked initially or if it is unresolved after a while (a non-union), then surgery is the best bet in my humble opinion. The scaphoid bone has a bad blood supply. It enters at the distal pole of the scaphoid and travels proximally towards the proximal pole. A fracture through the waist of the scaphoid (like what I see in the avatar) can compromise that blood supply and if that remains compromised for some time, you can get an avascular condition in which the proximal pole is wasted or degenerates. That means osteoarthritis in the wrist and some loss of dexterity. Even in the left hand it is a problem.
So I would keep tabs on that if I was you.
Edit: for those of you who are thinking 'What the hell is a scaphoid bone?'...it is one of the bones in the wrist near the base of the thumb in an area called the anatomical snuff-box. See
here for a detailed description. In fact palpation of the snuff-box is one of the clinical tests they do to check for tenderness that can be as a result of a scaphoid fracture.
