Hi, this is Omuric West Aizen with Cactin and Rhearsal Medicine. Today being assisted by Clint Hendricks, also of Cactin and Rhearsal Medicine. We're going to talk briefly about examination of the wrist where you have a suspected scatful fracture. Scatful fractures are common and the mechanism of injury is usually fall in an strange hand. When that happens, the dyslid radius and the second rive of the car is compresses the sky foot between the two of them, causing a fracture. There are four classical examination maneuvers ranging from very sensitive but not very specific through to more specific but less sensitive. The first thing that we're going to do when you have a sky foot fracture like this and you want to scream in sensitive teeth is simple radial deviation of the wrist. This causes the sky foot to be compressed between the second rive of the carbus and the dyslid radius as in the injury, causing pain. Please be gentle with your patient when you do this. It's not very sensitive though because any injury in the dyslid radius, any other carpool bounce in the radial compartment of the wrist or the base of the thumb or index finger metagarchals will cause pain so we need something that's a little bit more specific. The second test that we will do is telescoping of the thumb. Grab the thumb like so, make it nice and stable. We are going to take the wrist and stabilize it here again and then simply telescope the thumb into the wrist. Again, we are using the dyslid radius and the thumb to compress the sky foot. It's slightly more specific but again not specific enough yet for a final diagnosis. The third and classic test that we will do is snuff box tenderness. If you look at my snuff box, here you'll see it's formed by the ligaments of the thumb and the dyslid radius of the sky foot lying in there. The problem with just doing a finger in the snuff box is here you have a crowding of anatomical structures. Dyslid radius, sky foot, trapezium, trapezoid, base of the thumb metagarchal, base of the index finger metagarchal and a whole bunch of ligaments. The first thing you are pushing your finger on all of those structures is not giving you a lot of information about the sky foot itself. To make it more specific for the sky foot, you can do some only deviation of the wrist opening the snuff box up and then instead of using a big thumb or finger in there, take your little finger or if you have a small index finger and just press right on the sky foot. This will give you much better specificity when you do this test. Finally, the most specific test for this is if you take the wrist and look at the velour aspect of the wrist. Once the wrist is in slight extension, the tubercle there or the little bump there, that is the sky foot to burkle. So you will take the patient's wrist, extend it slightly and pull it on the sky foot to burkle. You can use a little finger if you want to. This is very specific but for distal sky foot injuries may not be that sensitive. And that's about it. Sky foot injuries and the examination of the wrist, suspected sky foot injury. You