1,2 This slow flow of blood supply makes the scaphoid prone to osteonecrosis after injury, especially of the proximal pole, which has been reported to occur in 13% to 50% of such patients regardless of treatment. The main blood supply is retrograde, with the more proximal 70% to 80% supplied by the dorsal scaphoid branches entering along the dorsal ridge. The scaphoid presents diagnostic challenges and can be difficult to treat, at least partly due to the fact that its vascular supply limits its ability to heal after injury. Our focus will be directed most at the proximal carpal row (scaphoid, lunate, triquetral), specifically the scaphoid.
Joining these bones are multiple ligaments and cartilaginous components. While elbows and hands may be affected, FOOSH injuries typically impact the wrist, which is relatively complex and composed of eight carpal bones and the distal radius and ulna. In this article, we provide a simple and concise approach to evaluation, assessment, and treatment of common FOOSH injuries in the urgent care setting. These can lead to significant morbidity and decreased quality of life. Such complications include avascular necrosis of scaphoid, scapholunate advance collapse (SLAC), and scaphoid non-advanced collapse (SNAC) wrist, as well as avascular necrosis and chronic pain. Adequate treatment, follow-up, and patient education are essential to minimize risk for long-term complications. While complex anatomy of the wrist, hand, and elbow often lead to confusion and misdiagnosis of FOOSH injuries, the high prevalence of these injuries makes it is imperative for urgent care providers to be proficient in diagnosis and management. Urgent cares centers play an integral role in providing care for patients who have sustained injuries due to falls on outstretched hands (FOOSH). Michael Bartuseck, MSN, ARNP, FNP-C, EP-C As such, evaluation, appropriate imaging, and initial treatment should all be within a clinic’s capabilities. Urgent message: It is common for patients with injuries to the upper extremity due to falls on outstretched hands to present to urgent care.
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