Disagreement over a Case Report Dx


Based on the magnetic resonance imaging (MRI) scans presented in the Case Report, “Bilateral wrist pain • limited range of motion • tenderness to palpation • Dx?” (J Fam Pract. 2018;67:160-162), I disagree with the diagnosis.

Contrary to the assertion by Drs. Shehata and Hizon that the patient had “fractures extending through the scaphoid waist,” this young girl actually had bilateral osseous contusions (ie, microtrabecular fractures) of the radial aspect of the scaphoid and did not have complete scaphoid waist fractures. Also, the MRI scans demonstrate intact ulnar cortices bilaterally, indicating that there is no complete scaphoid waist fracture.

These are typical “FOOSH” (fall on outstretched hand) injuries and would be expected to have an exceedingly good prognosis with immobilization. As to whether or not this affects medical management, such as how long the cast remains on the arm, I would have to defer to an orthopedic surgeon’s judgment.

David R. Pennes, MD
Grand Rapids, Mich

Continue to: Author's response


Next Article: