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Three Part Question

In [adult patients with a suspected scaphoid fracture but negative X-ray results], is [plaster of Paris or functional splinting] is better for [immobilization while waiting for a further investigation]?

Clinical Scenario

A 25-year-old right-handed carpenter came to the Emergency Department (ED) with a recent history of a fall onto his outstretched hand. He complained of pain in the wrist and some tenderness was reported in the anatomical snuffbox. The subsequent X-ray showed no abnormality. Should the patient have immobilization with POP or functional splinting while waiting for further investigation?

Search Strategy

Ovid MEDLINE(R) 1950 to June Week 4 2010
[exp Scaphoid Bone OR exp Carpal Bones OR scaphoid$.mp. OR exp Fractures, Bone OR fracture$.mp]
Limit to English language AND humans AND all adult (19 plus years).
AND
[exp Calcium Sulfate OR plaster of paris$.mp. OR exp Splints OR splint$.mp. OR exp Immobilization OR immobilization$.mp.]

Search Outcome

143 papers were identified in Medline, no paper was relevant to the three-part question.

Comment(s)

There were no papers was found in the literature searches. There is a similar BET that was developed previously and four papers were included which did not answer the question specifically, thus it is not a great example to be updated.

Clinical Bottom Line

More research needs to be done to compare between plaster cast and functional splint for immobilization in a patient with suspected scaphoid fracture while waiting for a further investigation..