#Scaphoid fractures

[siorasurgicals00]

An Educational Guide to Scaphoid Fractures

Severe scaphoid fractures may require internal fixation that involves the use of Orthopedic Implants Plates, pins, wires, and screws. Although in most cases, the condition can be managed with non-operative methods. This post will talk about the management of these fractures in detail. 

[ratcandy]

tomorrow morning i'm either freed from my shackle or sentenced to nail in wrist forever. here is hoping it is the former . and to the twenty or so of you who bet my wrist is broken i think you are very mean and cruel to me and i think you should explode. good day.

[jollygalaxycrown]

Expert Scaphoid Fracture Treatment in Dubai: Restoring Wrist Function with Precision Care

Discover expert scaphoid fracture treatment in Dubai, offering advanced techniques for fast recovery and restored wrist function. Get personalized care from top orthopedic specialists.

[samreensway]

MRCS PART A REVISION SERIES | ANATOMY | SCAPHOID CARPAL BONE OF HAND

MRCS PART A REVISION SERIES | ANATOMY | SCAPHOID CARPAL BONE OF HAND MRCS PART A - A LECTURE Bli medlem i kanalen för att få åtkomst till flera förmåner: https://www.youtube.com/channel/UCkkvon_blxinTHc7DGuYkpQ/join

[starkitten101]

Btw I’m finally out of my wrist brace =)

[ewrl0]

You know what, he’s done now. I don’t care if it’s not completely picture accurate. I don’t want to work on him anymore and have him looming over me LOL

So here. Enjoy this Angel Crowley I have been working off and on for, for the last… I dunno, few months 😅😬

He took a lot longer because it turns out, crushing your hand at work does actually break your bones. I’ve been walking around with a broken wrist since October (that I’ve fractured THREE TIMES IN FOUR MONTHS). Took off the entire top of my radius along with a nice pencil width chunk of bone the first time. I honestly don’t know how they missed that other than the fact that my doctors are absolute shit here. The second time, I displaced another chunk of the radius. And was told that was a sprain 😐. The third time, I fractured the previous ones again and seem to have nicked another chunk of bone off farther down the radius, messed my hand up so now I have an abnormal bump in it, and by how it behaves, probably broke the scaphoid too. But again, I wouldn’t know because the last doctor I saw did not look at it, X-ray it, or anything before he walked into the room, said it was fine, and then when called out on lying because my cousin is a radiologist and when she saw my X-rays, she freaked out and told me my wrist didn’t look good at all, he immediately backtracked and demanded to see the X-rays on my phone, compared them to when I broke my LEFT wrist in 2022 and told me that just because it was cracked, it didn’t need a cast. So, I’m kinda done with doctors right now and will just be letting this thing continue to try and heal itself without any immobilization like it’s been doing SINCE FUCKING OCTOBER. Doesn’t mean it doesn’t hurt like a bitch or is annoying by the fact that i keep dropping everything / go through excruciating pain.

On top of that, my bronchitis is back (it never exactly left, but it’s definitely back full force at the moment), and I can’t take a breath or move without hacking my lungs up.

[justkidneying]

The Snuff Box

I want to take a moment to talk about one of my favorite anatomical areas. I mean areas, as in arbitrary things like Hesselbach's triangle, the quadrangular space, the delto-pectoral triangle, and the...anatomical snuff box.

This is a region on the dorsal surface of the base of the thumb. It's a nice little triangle that appears when you abduct and extend your thumb. The tendons that make up the borders are the extensor pollicis longus (medial border), the extensor pollicis brevis, and the abductor pollicis longus. Within the triangle runs the radial artery and the superficial branch of the radian nerve. Under those structures are the scaphoid and trapezium (carpal bones), which can sometimes fracture when people fall on an outstretched hand.

Below the cut is my shitty diagram. But also, the reason this is called the snuff box is because it's a great little divot to hold cocaine powdered tobacco when you want to sniff it.

Correction: snuff is apparently powdered tobacco, and not cocaine. I don't think anyone sniffs snuff anymore, and you can still use this triangle to hold your coke.

[guardian-of-da-gay]

Wounds Heal, Scars Stay (Part 2/2)

Read on Ao3

For Whumptober 2024 Prompt 5: Healing Salve

tw for non-graphic medical descriptions, needles, implied medical trauma

(Part 1)

Finally they got their x-rays taken.  She showed Knuckles the bones in his hands, but he’d been forced to trade the lead apron for more wet towels and was busy looking annoyed and tired.  She was pleased to see that she could mostly recognize and identify each bone, with the notable exception of his spurs.  She was significantly less pleased to count four old fractures.  The fifth metacarpals on both hands, the right scaphoid, and an avulsion fracture in the left radial styloid which absolutely should have required pins but had managed to lump itself back together without them.

The metacarpals she could guess were boxing-related injuries, but the others were a mystery.

“I don’t remember that happening,” Knuckles replied when asked.  Maddie was tempted to follow up with ‘which time?’  They obviously hadn’t all happened at once.  But this wasn’t the time or place to push Knuckles for stories he might not want to tell.  What was most important was the x-rays confirmed that while there was a crack in his spur, nothing was broken and there was no sign of infection in the bone itself.  It was just… a really weird hangnail.  With a bad infection.

“There’s the problem.”  Maddie pointed to a shadow in Knuckles’ spur.  “You’ve got an abscess.”

“I don’t know what that means.”

“It’s when bacteria gets under your skin and your body sends an immune response so…”  Knuckles’ brow furrowed more and more as she spoke.

She remembered suddenly that Knuckles had grown up in the school of hard knocks, which didn’t have health class.  “So… do you know what ‘bacteria’ means?”

“Sickness.”

Well, that was a start.  “It’s more complicated than that but we can get into that later.  For now, yes, it’s sickness.  Um…”  She gathered her thoughts and did her best to describe the situation the way she thought Knuckles would:  “So you got hurt and the sickness got in through the wound.  Your body is good at healing, so it covered up the injury.  But the bad stuff was trapped inside.  And your body sent white blood cells–uh… “  Little warriors?  No, he might think there were literally little warriors inside him. “Your body tried to defend itself!  But the bad stuff has nowhere to go.  So now all of this is because your body is trying so hard to protect itself.”

Knuckles held the offending spur up to his face.  He fiddled with it with his good hand, glaring at the crack like it had personally betrayed him.  “So we must expel the sickness so that my body can return its defenses to its usual alertness?”

“... Exactly.”

“What do you wanna do, Dr. Maddie?”  Jade asked.

“Not sure yet…”  She looked to Knuckles and picked up his good hand, examining the spurs.  His brows furrowed at her handling, but he didn’t protest.  “Knuckles, did you say these grow?”

“They are like nails,” he said flippantly.  “They always grow.”

She had noticed recently, a dark point poking through the fabric of his gloves.  She’d assumed it was an underlayer and that the gloves were just getting frayed.

“Do you clip them?”

“I usually just punch some rocks without the gloves on and that wears them down.  Digging will take care of my nails.”

Crap.  She frowned down at his hand.  They’d been discouraging Knuckles from punching and digging unnecessarily.  She hadn’t realized they were important behaviors!  As she mentally kicked herself she absentmindedly palpated his left wrist, feeling the unevenness where the bone had forced itself back together.  Knuckles pulled his hand away.

He’d moved slowly, more fed-up than pained, but still she asked: “Did that hurt?”

“No.” Came his surly response. He didn’t meet her eye.

“Think we should call Hank?” Jade asked

“I wanna call Hank,” Ian chimed in with a cheeky smile.

“Baby, you always wanna call Hank.”

“I’m a simple man.”

“I don’t think we need to call a farrier just yet,” Maddie cut in.  “Jade, can you get an IV going?  And help me track his vitals, I want to keep an eye on them with this fever.  Ian, can you get the hoof kit?  I think it’s in the barn.”

“You want the Hoof Master?”  Ian asked as Jade hopped to it.

“What is a ‘farrier’?”  Knuckles demanded.

“Yes please,” Maddie answered Ian first.

“What is ‘eye-vee’?  And what is this ‘master of hooves’?”

“An IV is medicine that goes in your vein,” Maddie said.  “The Hoof Master is an electric tool to trim small hooves.  A farrier is a person who trims big hooves.”

Knuckles looked at her like he was trying not to call her stupid but was very much thinking it.  “Maddie, I do not have hooves.”

Maddie sighed.

Setting up the IV and patient monitor was another thing that was easier said than done.  On top of not quite knowing where to attach the sensors from a physiological standpoint, there were few places where his fur was thin enough to attach anything.  Which meant they had to shave some spots.

“No.”  Knuckles stood on the table.  He refused to sit while Ian held the clippers.  Most of the wet towels meant to keep his fever down were pooled around his feet.

“Knuckles, please,” Maddie tried to keep her pleading professional.

“I have never been shaved before.”  Knuckles crossed his arms.  “The fur might not grow back.”

“It will definitely grow back.”

“You don’t know that!”  He snapped.  “None of you have fur!”

“I know you leave red fur in the shower drain.  If your fur can fall out and you haven’t gone bald, that means it grows back.”

Logic was an unstoppable force, but Knuckles was an immovable object.  In the end, they had to compromise.  The patient monitor was put away.  The kitchen timer came out.  They would have to check his vitals the old fashioned way… every ten to fifteen minutes.  In exchange, Knuckles agreed to one tiny shaved spot on his forearm (where the cuff of his gloves would cover any extremely unlikely permanent baldness).

Maddie apologized to Ian, but he laughed it off.  “I’d probably have a few words to say if someone wanted to shave off part of my hair too.”

Knuckles watched with laser focus as Ian shaved the smallest little catheter patch ever.  Then Jade came in and started doing her usual catheter placement, wrapping it with several layers of medical tape and bandages… which Maddie realized wasn’t really necessary since their patient was unlikely to chew on his catheter, but no matter.  It eventually got done and Knuckles was sitting with his damp towels once more.

Ian got started tracking his vitals and found that Knuckles’ fever was holding steady.  Apparently it was just as stubborn as the rest of him.  According to Maddie’s notes, Earth echidna could tolerate some pretty extreme fluctuations in temperature, so she wanted to think he wasn’t as bad off as she feared but… but Earth echidna were small with brown fur and no teeth and couldn’t talk so clearly there were some dissimilarities between them and space echidna.  Maddie was hoping (praying) the IV would do the trick and help lower his temperature.

Ian listened to Knuckles’ pulse and breathing while Jade hung a bag.  Knuckles stared at the fluids.  Ian wrote Knuckles’ vitals out on one of their cage cards and set it beside the kitchen timer.  Knuckles only spared him a quick glance before his attention went back to Jade.

Maddie glanced away from her eldest as she drew up some lidocaine.  When next she looked, he was visibly tenser, his quills rising, fur puffed.  Jade was approaching with the IV needle.  Was he tense because of that?  He’d let her place the catheter needle just fine.

Jade reached for his good arm and Knuckles pulled away.  “I don’t think this is necessary,” He said very suddenly.  “It is not so bad.”  His eyes flit between the two of them.

“Honey,” Maddie said.  She could almost feel her patience physically fraying.

“Aw, are you scared of needles?”  Jade asked.

“Of course not!  I grow mightier needles on my backside than that miserable thing!”  Knuckles snapped.  Then his voice became more subdued.  “It is the venom the needle carries that I have a healthy caution toward.”  He glared at the IV bag.

“Oh, honey it’s not venom.  It’s medicine,” Jade reassured.  “Or sterile saline here.  Basically just really clean salt water.”

Knuckles watched with widening eyes as Ian pulled out a 60mL syringe and started drawing up sterile saline from a bottle.

“That’s more of the same,” Jade said.  “Purified water with salt.  Not venom.”

“I’ve had it be venom,” he grumbled.  It was so quiet, Maddie wasn’t sure he’d meant for them to hear.  But they both had.  Even Ian looked up from his task, one brow raised.

“Really?”  Jade asked after a long pause.  “Someone injected you with venom?  With a needle?”

Knuckles glared even harder at the syringe in Ian’s hand.  “From the Violet-bellied Basilisk.  That was… an eight.”

“An eight?”

“Out of ten.”

“Oh,” Jade’s eyes widened.  “Wha–why on Earth would someone inject you with that then?”

“I cannot say ‘Why on Earth’ because it was not on Earth.  But in Sandopolis, it was to see if I could withstand it.”

Maddie’s stomach plummeted, her gaze falling back to the notebook on her lap.  She took a hard, deep breath through the nose, blinking rapidly.

Jade was thrown.  “Oh… I’m… sorry?”

Knuckles blinked and looked away from the syringe at last.  “There is no need for apologies.  It was not your doing.”  His eyes flicked between the three of them.  A painfully silent moment passed and then he puffed his chest and hit it with his good hand.  “As you can see: I withstood it well!”

Jade turned to Maddie, who was frowning deeply at her notebook like the measly records could keep her from spiraling.

The thing about her kids was… they all had baggage.  The thing about Knuckles was… she had no idea what that baggage was.  Sonic grew up alone in the wilderness.  When he shared a bad story from his past, it connected back to that.  Tails was orphaned and ostracized for being different and it was the same for him.  Their stories were heartbreaking, but not… Surprising?  At least not compared to Knuckles.  He was a complete wildcard.  She never knew what he’d casually unpack in front of her (or others).

Like someone injecting him with a powerful venom just to see if he’d survive.  Using a needle.  Like the one she was about to stick him with.

“Okay.  So that.”  She pointed to Jade and Ian’s needles.  “That’s sterile saline.  It’s just what she said, really clean salt water.  It might feel cool going in, but it won’t hurt.”

“And this?”  She held up her syringe.  “This is lidocaine, not venom.  It won’t hurt.  It will do the opposite.  It’s a medicine that numbs pain.  It might pinch when I poke you and you might feel a bit of a sting when the medicine goes in, but… well if your hand feels like a one then this really will feel like a zero.  I’ll inject it a few times in a few places and then we’ll wait a few minutes for it to kick in.  You won’t be able to feel your hand for 30 minutes to 3 hours.  But you will get feeling back… do you trust me, honey?”

She realized immediately that she didn’t really want to know the answer.  She didn’t think it was one she would like.  Knuckles hadn’t seen fit to tell her he’d been injured, had he?  He’d thought it would be better to hide it.  And he’d been nothing but uncomfortable and distrustful here in the clinic, not even with her by his side.

Knuckles didn’t actually answer though.  Just grunted and held out his good arm with the catheter toward Jade.  To Maddie, he said: “I already let you inoculate me.”

That was true.  They’d stayed outside and he’d stayed standing and he’d still watched her like a hawk when she had the needle in her hand.  Now she had some rather distressing context for why.  But she didn’t have time to get upset here.  Knuckles may have had worse pain then, but she couldn’t fix that.  He was in pain now, and this she could fix.

Maddie made a point to explain what they were doing as much as possible after that.  It wasn’t quite what she was used to.  She didn’t usually have to explain procedures to her patients as she was doing them.  But for Knuckles, it worked out well as a distraction.

“If it is poison to eat, why do you put it in my veins?”  Knuckles asked, watching quietly as she shaved around the infected spur.

Maddie didn’t look up from her task.  “It’s not poison.  It’s just more effective if it goes directly to the circulatory system and bypasses the liver–”  She paused and glanced up at Knuckles to see the understanding dwindling in his eyes.

Maddie used surgical scrub wipes to clear the clipped fur away.  “Uh… because it’s not compatible with your–” Liver.  Digestive System.  “--Stomach.”

Knuckles grunted.  “Is that why inoculations go in the vein?”

“Yes.  Kinda.  That's where it’s needed most after all.”

He huffed, though it was more tired than annoyed.   “Isn’t it needed everywhere?”

Wow, it just occurred to Maddie that Knuckles had let her vaccinate him with zero idea of how they worked.  Well, they had to wait for the lidocaine to kick in.  It was excellent timing for a little lesson.  Especially since now she knew these breakable spurs needed to be worn down on rocks and trees.  As soon as he was well again, she was definitely going to give him a tetanus booster.

Jade adjusted their surgery light to where Maddie needed it.  Maddie put on her gloves.  Knuckles watched her carefully when she picked up the scalpel blade, but he didn’t seem half as uncomfortable with that as he’d been with the lidocaine.  She cut the numbed skin and set the blade aside.  His lip curled back as she got to work expressing.  He assured her he felt nothing when she asked, so she chalked it up to disgust.  It was pretty gross.  And smelly.  But not the grossest or the smelliest Maddie had faced, and she had faced plenty.

She rarely did full sedation to flush a ruptured abscess, so having her patient awake was not new.  Having her patient staring intently the entire time?  That was a bit different.  Having Ian staring intently the entire time?  Normal.

“It’s like watching a train wreck, I can’t look away.”

“You’re nasty,” Jade said.

“Pimple popping videos are totally a thing on Youtube.  My people are out there.”

“Your people are nasty.”

Knuckles tensed when Maddie brought out the big 60 mL syringe of sterile saline.  She assured him it was just more of what was in the IV, but he still jumped when she started flushing the wound.  He settled himself quickly, trying to look like he hadn’t been startled.

It took a second syringe to clear out the debris, but finally it was done.  Maddie stretched her hands and wrists while Ian cleared away the dirty towels and puppy pads.  Jade did another temp check.

“Ninety three point six,” she read off with a smile.  “We’re going down!”

Knuckles must have been feeling much better.  His temperature was down and his painful hand was numb.  But when he turned to Maddie, he held his head low.  “Does this mean we can leave?”

Maddie hummed thoughtfully as she stretched.  It wasn’t like there was much more she could do here at the clinic.  She really wanted to get some NSAIDs onboard before she took him away from the IV and all her other supplies.  What if she took him back and his fever got worse again?  But she didn’t know how much to dose him for medications.  Unless…

“We can go home if you take medicine and let me take some blood samples so I can check and see that the medicine works and doesn’t make you sick.”

Knuckles sighed.  He didn’t answer for a very long moment and then finally replied: “Fine.”

Not enthusiastic consent, but Maddie was used to that from her patients.  She gave Jade a nod and the tech disappeared and reappeared with syringes and blood sample tubes.

Maybe Knuckles was tired, maybe it was because the needles were empty, or maybe it was because they didn’t ask to shave him first, but he tolerated the blood draw better than anything else they’d done.  Maddie held off as Jade pulled the needle out.

No sooner had they finished then Ian was there with the hoof kit and dremel.  “I got the Hoof Master, Dr. Maddie!”

Knuckles stared at the dark little case with one brow raised.

“Alright, Knuckles.  Lay your hand flat like this–”  Maddie demonstrated on the table.  “--And I’ll try and trim down these spurs.”  ‘Try’ being the operative word.  She’d never trimmed space echidna spurs before.  “Do you want more lidocaine?”  She asked, pinching around his hand.  “Still feeling numb?”

“Zero out of ten.”

She smiled obligingly as she plugged in the hoof dremel.  Maddie hadn't used one since she was a vet assistant herself.  She would've killed for a battery-powered one like this.  She turned on the machine and its high buzz filled the air.

Everything exploded into chaos.

Red sparks burst across her vision and the room went black.  All the air left her as she bounced off the kennels.  Ian fell over the instrument tray.  Tools clattered on the floor.  Across the room, Jade yelled.  Knuckles was the easiest to spot--glowing bright red, he pinballed off the ceiling.  He smacked back onto the ground and uncurled, legs scrambling.  He flew down the hallway.  The IV pole and red electricity trailed after him.

The emergency generator groaned as it kicked on.  The lights flickered back to life just as unsteadily as the rest of them getting to their feet.  The dremel whined away on the floor.  For a moment, Maddie was too shocked to do much more than reach down and switch it off.  Then she went into crisis mode.

She took two fast, long strides to reach Ian.  "Are you hurt?"  She asked.

"No," Ian said faintly.  He moved to put his hand down and push himself up and she grabbed him.

"Watch out!"

"Oh shit!"  He yanked his hand away from the scattered tools.  "I mean–crap!   Um.  Watch your step everybody.  I got a lost sharp!"  He crouched over the mess and began gingerly going through the instruments.

Jade next.  She was, of course, covered in blood.

"Oh my God!"

"I'm fine," Jade said.  "Fell right on my butt, but I'm fine."

"Holy shit, Jade--" Ian moved to stand but Jade held out a hand.  She was holding a needle.

"I squirted Knuckles' blood all over myself," she explained.  She frowned.  "This is gonna sound like a joke, but I'm serious: is this a bio-hazard?  'Cause animal blood is fine but--"

"Probably better safe than sorry." Maddie looked around.  Her coworkers weren't hurt but it looked like a tornado had hit. Everything was knocked over or pushed back.  Papers, cleaning supplies, towels, and pet treats had been thrown off tables and scattered across the floor.

"Okay.  I'll handle this, you go take care of your boy," Jade said.

"Do you... need help with your boy?"  Ian looked up from collecting the tools.  Restraining patients so they didn't run away or bite her was a big chunk of his job, but Knuckles wasn’t a vicious dog, he was her kid.

"No, I'll talk to him.  I'm so sorry.  I'll be right back."

She was feeling a lot of different ways right now.  Concern and embarrassment and anger and guilt and confusion.  Why on Earth had Knuckles reacted like that?  She didn't know he could react like that.  Well, she sort of knew.  Sonic had told her Knuckles had a power like his, but she'd never seen him get so emotional he started glowing like Sonic did.  She'd only heard that he could do it when fighting.  She didn't know what to make of his using it in the clinic.  They were pretty much done with everything.  He'd been okay with getting his blood drawn.  Hadn't he?  And why, why couldn't he have used his words to convey it if he hadn't?  He hadn’t hesitated to be uncooperative all evening!

Should she be angry?  She felt she should be angry.  Her guilt and concern over him had granted him a lot of patience tonight and he had really been stretching it.  And now he'd done something destructive and dangerous--any one of them could have gotten badly hurt!

And yet, she couldn't help but feel a sense of fearful dread.  It just... it didn't feel right.  The way he'd balled up and darted around and scrambled across the floor... that did not feel like her Knuckles.  Something was wrong.

She hurried down the side hall.  She'd locked her office door when she left earlier but that hadn't stopped Knuckles.  It hung on its hinges, the frame splintered where the lock used to be.  The IV pole lay jammed across the doorframe.  

"Knuckles?"  She gently opened the battered door and was greeted by a dark room.

The IV spike had been ripped out and the bag was gushing saline into a growing pool on the floor.  Everything else was as she'd left it.  Her notebooks were all in place.  Paperwork she'd planned to start on Monday sat waiting for her on her keyboard.  The only window in the room was a narrow, horizontal panel up by the ceiling.  Thankfully this hadn't suffered the same fate as her door.  Nothing was out of place except for her desk chair, which had been toppled over and lay on its side.  The rest of the IV line trailed beneath the desk.

She could hear quiet, fast breathing.

Something told her she should keep the light off.  As she entered the room, she only had the light from the hall to guide her.

“Knuckles?”  She spoke softly.  Stepping carefully around the puddle on the floor, she crouched to look beneath the desk.

A pair of red glowing eyes stared back at her.  Knuckles’ quills were flared up.  He probably would’ve looked big and scary if he weren’t hiding under a desk.  As it was, it was only the wide, glowing, unblinking eyes that made her hesitate.  If a dog looked at her like that, she would keep her distance.  But he wasn’t a dog.  He was her kid.  She pushed past the feeling.

“Knuckles?”  She reached for him.  “Honey, you’re not in trouble.”  Knuckles’ gaze zeroed in on her hand.  

Her instincts screamed.  She yanked her hand back just as Knuckles lunged forward.  His teeth snapped on open air.  He flung himself back again, the desk thumping against the wall.

The glow vanished and he blinked at her.  He looked as shocked as she felt.  Then his face crumpled and she saw an expression she’d never expected to see on him:  shame.

“It’s okay–” she tried.

“I apologize!”

“I’m not mad!”  She was too surprised to be mad.

Despite all his bluster, the ‘how dare you’s and ‘you’ll rue the day’s, and the fact he could bench press a truck, Maddie had never been scared of Knuckles.  He’d certainly never been scared of her.  Now here they were.  

But… he’d been scared all evening hadn’t he?  It all seemed clear now:  Knuckles dragging his feet, being as uncooperative as possible.  The hidden scars beneath his quills.  The bones healed without any medical attention.  A syringe of venom that could have left him dead.  An eight he’d called it.  Had he faced a ten?  Had he faced it in a place like this?

She felt like a newby vet assistant again, bumbling all over a frightened dogs’ triggers until it snapped and had to be muzzled.  She could have prevented this somehow, she was sure.  If only she’d paid attention.  If only she’d noticed.

“You have been mad.” Knuckles spoke so quietly, she was sure she wasn’t meant to hear him.

“I haven’t been mad.”  She floundered.  Her face flushed, feeling caught out.  She’d been trying so hard to not put her frustrations on her kid.  He’d picked up on it anyway.  Just another thing she’d failed at tonight.

“You have,’ Knuckles scowled at his injured hand.  “Will I be grounded?”

Maddie didn’t know.  She didn’t know where the bite had come from, but it hadn’t been a conscious decision on his part.  She’d probably punish him if he punched one of them but… The look in his eyes right before it happened flashed through her mind.  She’d seen it on animals before, but never thought one of her kids would ever turn it on her.  She didn’t know what to do with that quiet terror… But she didn’t think she should punish it.

“I’m not going to ground you,” she said.  “And I’m not really mad at you…”  Knuckles was honest to a fault, he might appreciate some honesty in kind.  “I’m mad at myself.”  Now it was Maddie’s turn to stare at Knuckles' hurt hand and nothing else.  “I’m mad that I’m a healer and didn’t even notice you were hurt.”

“You did though,” Knuckles said, his brows furrowed.  “You said I felt warm and discovered my fever.”

“I should’ve realized before then,” she said.  “I’m meant to look after you.  And… okay, yeah, I’m a little frustrated with you too.  I wish you’d told me.  If I’d known right away we could’ve avoided all of this.  I just want to help you feel better.  But you aren’t going to be punished.  I’ll never punish you for being hurt.”

“Will Tom?”

What?  “No?”

“But you will tell him that I–” he winced, “--I almost hurt you?”

Maddie shook her head.  “Tom doesn’t need to know everything.”

“But he is your husband!”

“And you’re my kid!  That means sometimes I’ll cover for you.”

Knuckles suddenly became extremely fascinated with his injured hand again.  “Oh,” he said softly, playing with his numbed fingers.  “Okay then.”

Maddie watched him for a moment.  He looked so small under the desk.  It was crazy to think of him as big when he was waist-high, but he always seemed larger than life.

“Do you want to go home?”  She asked.

He lifted his gaze and nodded silently.

“Okay.”  She righted her desk chair and patted the seat.  “Do me a favor and prop up your injured hand?  I’m going to get stuff to wrap it and then we’ll go.”

When she reentered the treatment room, Ian was mopping the floor with bleach while Jade was at the computer wearing a set of scrubs a size too large.  They both looked up expectantly.

Maddie tried not to cringe.  She felt awful that she’d called her friends in so late and they’d had the worst appointment ever.

“Is Knuckles alright?”  Jade asked.

Not really.  “He’s ready to go home.”

Maddie looked around at the damage.  Ian and Jade had focused on cleaning up the biohazard.  The rest of the treatment area was still a mess.  There was also a gouge in the ceiling where Knuckles had pin-balled around.  That, she couldn’t fix, but the rest was do-able.  “I’ll come in tomorrow and clean up the rest of this,” she said.  “You guys should go home too.”

There were some mild protests, but Maddie wouldn’t hear of it.  They had gone above and beyond tonight.  She owed them a week’s worth of lunches.  At the very least, she owed it to them to do the cleanup herself.

“Tell Knuckles we hope he feels better,” Ian said as he stood at the back door.

“Then tell him to come visit us after,” Jade tacked on.  She pulled her purse strap on over her oversized scrubs.  “Seriously, we should do some happy visits.”

Maddie could only tiredly agree.  Jade reached out and pulled her into a big, welcomed hug.

Then it was just her and Knuckles.  She loaded a tray with supplies to wrap his hand, took a deep breath, and headed back to her office.

Knuckles was out from under her desk.  He sat cross-legged on the floor, shoulders curved in.  He’d propped his bad hand on her chair like she’d asked.  When she walked in, he looked up at her and then away again.

“Are your companions alright?”  He asked his shoes.

Maddie sidestepped the saline puddle on the floor and set down her tray.  “They’ll be alright,” she said.  “They hope you feel better.”

“I… apologize again.”

It was so weird to hear him say that.  Weirder still that it happened when she didn’t want him to feel sorry.  “No one was hurt,” she said, ripping off a long strip of vet wrap.  “And they understand you were–” terrified “--freaked out.”

“Do you still need to cut my spurs?”

“No, we’ll do it another day.  Right now, I’m gonna take out the catheter we put in, okay?”

Knuckles hesitantly gave her his good hand and she worked quickly and quietly to cut the bandaging, remove the catheter, and place a temporary pressure wrap.

When Knuckles finally spoke his deep voice came out surprisingly high and reedy.  “Will you–”  She paused immediately and looked at him, but he was still staring intently at his shoes.  He cleared his throat.  “Will you use the screaming machine?  To cut my spurs.”

“You mean the dremel?”  She asked.

Knuckles traded staring at his shoes for staring at the wall, his chin sinking into his chest.

Was that what set him off?  She’d had some patients react strongly to the noise of the dremel, but they couldn’t understand what it was or why they needed to use it.  Why would Knuckles be so terrified?  But no, the ‘why’ didn’t matter.  Knuckles hadn’t reacted half as badly to the injections and she knew why he hated those.

“No,” she said.  “No ‘screaming machine’, I promise.”

She didn’t want Knuckles to be punching rocks to wear down his spurs when he was still nursing this injury.  Maybe she would call the farrier.  He’d obviously never worked on alien echidna spurs, but he was good with all kinds of temperaments, from skittish to aggressive.  And he mostly used simple hand tools that Knuckles could easily understand.

For now though, she was going to help him keep this wound clean.  Maddie pulled on a new set of gloves and grabbed a little box off her tray.  She ripped the seal, drawing out the tube inside.

“What’s that?”  Knuckles’ voice did that reedy thing again.

There she went again, doing things and not explaining.  “This is a special kind of honey called manuka honey,” she said.  She showed him the little tube.  “Usually I would leave this kind of injury uncovered, but…” She wasn’t confident he would follow her orders and keep his hand clean and dry.  “Since I’ll be able to do dressing changes at home, I’m just going to apply this to your wound before I wrap it.”

Knuckles stared at the little white tube, brow slightly furrowed.

“Is that… okay?”  She asked.

“It’s fine.”

He kept staring as she squeezed a healthy amount of honey onto his injury.  The cinch in his brow loosened slightly.  She used a tongue depressor to smear it around, then went back to her tray to grab her primary dressing.

Knuckles leaned forward to examine his hand.  He sniffed it once, then again, deeply.  His eyes closed and his shoulders sagged.  She tensed.

Why was he going slack?  Was he allergic to honey?

She opened her mouth to ask if he was alright, but he spoke first:  “My people used honey to treat wounds, too.”  He opened his eyes and looked at his injury.  “It smelled just like this.”

Oh.  Oh.  Not a bad reaction then.

“That’s… cool,” she said genuinely.  Humans had been using honey for so long, it was fascinating to hear that bees had developed on another planet and another culture had decided to use their honey as well.  A smile crept up on her.  “You know, this kind of honey is from Australia.”

Knuckles lifted his head.  He knew only one fact about Australia: “That’s where the Earth echidna live.”

“Mm-hm.”

Knuckles hummed thoughtfully.  “Fate gave both planets echidna.  I wonder if it is the same kind of honey then,” he said.  A ghost of a smile found his face.  “Or perhaps not.  Perhaps our manuka flowers were bigger.  With red petals… and teeth.”

“And they could talk?”

Knuckles nodded and Maddie actually let out a little laugh.  She handed him the little tube.  “Do you want to hold it for me?”

He obliged.  She worked quickly to finish wrapping his wound and removed the pressure bandage from his good hand.  All the while, she waited for him to protest or put up some resistance.  Instead he just periodically sniffed the little tube.

“When you change the bandages, will you use this again?”

Maddie would put honey-scented diffusers around the house if this is how it made him feel.  “Of course,” she said.  “Now, let’s go home.”

Maddie was still learning what made her two new kids tick.

Knuckles was independent.  Too independent.  He wouldn’t communicate if he had a problem.  And he didn’t like situations where he wasn’t in control.  He was scared of situations where he was vulnerable, and it was a learned fear.  He had a lot of big, bad, hidden things in his past.

But if Maddie paid attention, she might notice the small, good things too.

[radioactiveradley]

It’s SPOOKY SCARY SKELETONS MONTH

So let’s talk about yer bones! Yeah, that’s right, Captian Holt. I said –

An adult has (roughly) 206 bones (I say ‘roughly’! You can have non-pathological anatomical variation, such as lumbarised sacral vertebrae (an extra bone in your back) or accessory sesamoids like the flabella (a little bone at the back of the knee!))

A newborn has (roughly) 300 bones

That's a big difference! Almost 100 bones of difference! Where do they go?

Well, you see - as you get older, every time you come into the hospital we steal more of your bones...

Just kidding.

...Or am I

As an embryo, your skeleton is completely composed of cartilage. This gradually ossifies as you age, until, as an adult, you have a full skeleton, with only the interactive portions of joints being capped with hyaline cartilage.

[Paediatric normal whole leg radiograph, showing epiphyseal plates around the head of the femur, the femoral condyles, the proximal tibia, the distal tibia and the lateral malleoli that can mimic fractures. Courtesy of radiopaedia]

See all those weird blobs? Those are bones in the process of fusing together! The transverse lines that could be mistaken for fractures are actually epiphyseal plates – hyaline cartilage bridges between the shaft of a bone and what will become its tip, which don't attenuate x-rays, and thus appear black on our radiographs! This is where bone growth occurs - the cartilage forms a sort of template matrix that then ossifies into bone.

Compare our paediatric radiograph to the AP knee radiographs of an adult with no visible pathology:

[Adult normal AP knee radiographs, showing fully fused bones. Courtesy of radiopaedia]

See how all those ragged pieces have joined up? That’s endochondral ossification, BABY!

This is how we can figure out the age of a paediatric service user from their bones! Certain bones form at different times.

Let’s check out the carpal bones – all those fiddly little bones in your wrist! Anyone who’s binged Hatecrimes MD – sorry, House MD as often as I have will know the classic acronym for remembering the names of these bones. Moving thumb side to pinkie side, we have…

Scared (Scaphoid - red)

Lovers (Lunate - dark blue)

Hate (Hamate - green)

To (Triquetrum - yellow)

Try (Trapezium - orange)

The (Trapezoid - light blue)

Coolest (Capitate - purple)

Positions (Pisiform - pink)

[Normal adult wrist radiograph, shown with and without coloured carpal bones. Courtesy of radiopaedia.]

But did you know that these bones form at different times?

The Capitate ossifies at 1-3 months

The Hamate ossifies at 2-4 months

The Triquetrum ossifies at 2-3 years

The Lunate ossifies at 2-4 years

The Scaphoid, Trapezium and Trapezoid ossify at 4-6 years

And the Pisiform ossifies at 8-12 years

So, I can look at this picture, and tell you that this child is approximately 3 years old, because their Capitate and Hamate have ossified, and their Triquetrum is just visible, starting to ossify below the thumb (circled!)

[Normal wrist radiograph of a paediatric patient, triquetral ossification centre circled. Courtesy of Radiopaedia.]

Your bones continue to form and fuse until you reach about 25! Your olecranon (the bump of your elbow) starts to ossify at 6-11 years, and fuses at 13-16 years! We can look at the base of your fifth metatarsal to age afab folks who are approx. 10 and amab folks who are approx. 12, as this bone fuses in the 2-4 years following these ages! The medial end of the clavicle can be used to assess your age from approximately 18-22, and your facial bones continue to ossify into adulthood! How cool is that?

If you’re over 25, fret not – there’s still plenty of funky stuff happening to your bones. But we’ll get into all of that next time, when we take a look at the function of osteoblasts and osteoclasts and explore all the cool little jobs that your bones perform within your body - it's more than you might think! So, tune in next time for more Bone facts...

And thank you for reading!

[tennessoui]

Are you fucking insane for the obikin firefighter au pls 🥺

hello! picking away at these. have some stupid firefighter anakin and stupid rockstar obi-wan, aka the firefighter au

(1.3k)

“I’m alright,” isn’t quite on the top ten list of things you want to hear from your boyfriend within two seconds of picking up the call.

Anakin is already pulling the phone away from his ear in order to pull up Google. 

There are many benefits of dating a rockstar. One is that Obi-Wan Kenobi can’t even scratch his nose on a slow news day without Anakin’s Google alert going off. 

“What happened,” he’s already asking as he waits for the page to load.

“Nothing,” Obi-Wan sighs, but he’s very clearly lying or he wouldn’t be calling Anakin at—eight in the morning, his time.

“Nothi—what the fuck, Obi-Wan? You fell off the stage?”

“I was distracted!” 

Anakin’s eyes skim the tweets that have loaded. “You broke your wrist?”

“I’m alright!” 

“Are you calling from the hospital?”

“It’s more of a sprain really. The report of my broken wrist, you know. It’s been greatly exaggerated.”

Anakin gives the wall in front of his bed a disgusted expression, even though it’s not nearly as satisfying as it would be to level that look at his boyfriend. “You’re not calling from the hospital.”

“We keep a medic on standby,” Obi-Wan’s voice is purposefully light. “They know how to set wrists.”

“You said it wasn’t broken.”

“Anyway, darling, I just wanted to make sure you understood there’s nothing to be worried about—it’s a simple sprain, our doctor has set it, I’ve been given painkillers, and I’ll be ready for tonight’s performance.”

Anakin narrows his eyes. He loves Obi-Wan. He adores the man.

And he knows better than to trust him when he uses that tone of voice.

Obi-Wan Kenobi’s hand could probably be sawed off and he’d try to tell Anakin he’s alright.

This is the man that burned down his own house by accident, after all. Anakin’s opinion of him is both very high and incredibly low.

“Now that you know, I’ll let you go. I understand it’s very early where you are and you should go back to sleep. I’ll talk to you later, baby, I—”

“Are you fucking insane?” Anakin rolls onto his side, burrowing under his blankets now that he’s relatively sure his boyfriend isn’t dying. “Go to the hospital.”

“For a sprained wrist?” Obi-Wan sounds forcefully incredulous, as though Anakin is being unreasonable here. “Darling, that’s a bit of an overreaction, don’t you think?”

“You’re hurt, Obi-Wan,” Anakin frowns at the ceiling. “Hurt people go to the doctor. So the licensed medical professional with access to professional medical equipment can examine you. And diagnose you. Not some roadie probably still drunk from the night before.”

The other end of the line is silent, like Obi-Wan is trying to figure out an argument. But of the two of them, Anakin is the one trained in emergency medical services, so he thinks there’s a good chance of him being able to out-stubborn Obi-Wan on this one.

He rolls back over onto his back, taking the phone away from his ear. “Did you know,” he says, fingers flying across his phone’s keyboard, “that a sprained wrist, if untreated, can lead to early onset arthritis? And sprained wrists are misdiagnosed all the time. It could be an unrecognized fracture in the scaphoid bone, which could worsen over time without proper treatment—”

“See now, why on earth would I go to the doctor’s when I can just have you Google things for me?”

“If your wrist wasn’t permanently damaged, you’d be able to google these things for yourself,” Anakin points out, scratching at his bare stomach idly. “Look, an unrecognized fracture in the  scaphoid bone can lead to worsening fractures through the bone and in some cases even death.”

There’s a second’s pause before Obi-Wan’s incredulous laughter rings down the line. 

“Come on,” Anakin whines, even as a smile tugs at his own lips. “You woke me up at four in the morning, alright, I’m not firing on all cylinders here.”

“No, no, this is valuable information, please tell me more about how my sprained wrist is going to lead to my death if I don’t go to see a trained medical professional.”

Anakin glowers at the ceiling. The short answer is, of course, that Anakin is going to kill him.

But there’s a niggling thought in the back of his head. “I think the question here is why you’re so against it,” he says slowly. He blinks. “Wait. I’ve never seen you go to the doctor’s.” He sits up, pressing his phone back against his ear. “We’ve been dating for two years and I’ve never heard of you going to any sort of doctor’s office for annual check-ups.”

“That’s patently false,” Obi-Wan protests, but Anakin can hear the slightest hesitation in his tone. The higher octave he only ever hits when he’s really and truly nervous. “I showed you my test results from the clinic.”

Anakin frowns. That is true. Obi-Wan had insisted on getting tested—on both of them getting tested—before they could leave out the condoms. Anakin had his done the next day. 

But it had taken Obi-Wan weeks.

“Oh my god,” Anakin says. “Are you—Obi-Wan Kenobi, are you afraid of going to the doctor’s office?”

“No,” Obi-Wan says so immediately that he must understand how that sounds as he starts back-tracking at once. “Of course I’m not. Of all the silly things to say, Anakin, really.”

“You refused the ride to the hospital,” Anakin says slowly, piecing things together in his mind. “That night we met. Your kitchen fire. I was worried there could be smoke in your lungs, damage, but you refused to go in the ambulance. I always thought—you just drove yourself. But you didn’t go at all, did you?”

Obi-Wan sounds incredibly flustered. “It would be absolutely foolish to be scared of doctors.”

“Obi-Wan.”

“I mean, first of all, I am practically ancient, Anakin. I’ve gone to the doctor’s more than once in my life.”

“Obi-Wan.”

“What is there even to be scared of? They’re just—I mean, of course, they. You know. Cut you open if they decide it’s necessary. And they’re quite rude, you know. And they can keep you undder observation as long as they’d like even if you don’t consent, there’s that too, but I mean. Doctors are people. Nothing to be scared of.”

“Obi-Wan.”

“Now. I mean. Disquieted by? That’s…that’s understandable. Practically to be expected. And hospitals? Aren’t hospitals a tad…disquieting as well? Have you ever thought about it?”

“Alright, Obi-Wan, now you definitely need to go to the doctor’s office. You must be way overdue on about a thousand different check-ups. This isn’t optional.”

“Anakin Skywalker, I am in my mid-forties. You cannot make me do anything.”

Anakin snorts.

“Not that I would have to be made to visit the doctor’s office, of course. I simply do not want to waste their time with a simple sprain. Time is valuable after all. Practically money.”

“Obi-Wan, you’re going to go to the doctor’s. It’s non-negotiable if I have to fly down there and drag you there myself.”

“I’d like to see you try,” Obi-Wan scoffs, and Anakin narrows his eyes, trying to dissect the man’s tone.

He sounds derisive. Defensive.

And something that sounds a lot like longing.

It’s been a few months (two months and six days) since they were able to see each other in person, what with Obi-Wan recording another album and Anakin’s work schedule.

But  if he were facing a task that he didn’t want to do—that perhaps he was afraid of doing, he’d want Obi-Wan by his side. As selfish as it would be to ask, to tear his boyfriend away from his very important life and job just to have him by his side….he’d want to.

He thinks maybe if Obi-Wan were a little less prideful, he’d ask.

Thankfully, Obi-Wan never has to ask. Not for Anakin’s presence. 

Not for Anakin to hold his hand, even if he has to fly a few hours to do it.

After all, there are thousands—maybe millions of people in the world who are invested in Obi-Wan Kenobi’s hands being at top form.

But no one’s as invested as Anakin is. That’s for sure. He's quite in love with Obi-Wan's hands and his wrists and his whole body and....he checks google. And his silly, perfect iatrophobic self.

[ratcandy]

Haha itd be soooo embarrassing if my wrist was just sprained and not broken this whole time haha… like I’d hate that haha omg like how humiliating… I side glance my wrist to see if it’s listening

[sanguinaryrot]

I realize this is only really relevant to me, the single Kienböck's-having vexilography enthusiast on the planet, but making art and graphics has always been a good way for me to handle stress. So i present: The Keinböck's Disease Awareness Flag.

Kienböck's Disease is avascular necrosis of the lunate bone, or bone death because of lack of blood flow in one of the eight bones in your wrist called the lunate. This causes pain, stiffness, swelling, and decreased range of motion and grip strength. There is no cure, but treatments to alleviate pain and pressure in the wrist include radial shortening (fracturing and shortening the radius bone of the arm) or a Proximal Row Carpectomy (removing three wrist bones.) Out of every 100,000 people who have their wrists scanned, around 7 will have Kienböck’s Disease.

the eight stripes represent the eight bones in your wrist: the hamate, capitate, trapezoid, trapezium, scaphoid, lunate, triquetrum, and pisiform bones. The sixth stripe is the lunate, which is red to represent the inflammation, chronic pain, and stiffness associated with the disorder.

[mintoxhitsuji]

This is Horea Minovici, a payara piscis. He is 19 years old, 180 cm tall, goes by he/ him and is gay. When he moved to Japan he took on the alias of Zāzākun, which goes with his boyfriend Emil‘s nickname, which is Sakachan.

Horea is very much aloof from the outside, he wants to look stronger than he actually is. But on the inside he is a raging torrent of emotions; he easily cries, either out of anger or happiness, has a quick-tempered personality, and is very sensitive to the emotional distress of other people. He often blames himself and gets quickly jealous and overprotective over his boyfriend. Zāzākun deeply loves his better side and would do anything for him, Sakachan gives him a sense of safety and being needed, although their love risked a lot of things in their lives. So much so that they had to move from their home in Romania to Japan.

The payara piscis works as a model for fashion and make-up ads and magazines. He is very satisfied with the work he does, although it can be very stressful. This job is his everything and currently the only source of income of the two piscis boys. Emil is studying at the local university, so he isn‘t really earning anything. This became somewhat of a problem one day, because Horea had a little accident where he suffered a scaphoid fracture. He found himself in the hospital, where he met Katsuro. They found themselves in the same boat, facing both mental health issues.

Horea is a born swimmer, it always was his favourite hobby and it always will be. He loves to play around with clothes and make-up, expressing his style however he feels like. Sometimes he organises his own photoshoots with his friends, dressing them up and doing their make-up.

[grict]

Hello, I am back since I got injured on the job (scaphoid fracture), so I have wayyy too much time on my hands.

[grahamkennedy]

I fractured my scaphoid just under a week ago and I still don’t know what I’m allowed to do with my hand and I still don’t have a cast. The Australian healthcare system is an absolute joke. It should not take this long to get a cast on a broken bone.

[prettypangolins]

hello, good afternoon i'm here to tell a funny (but maybe also cautionary) tale

i fall over a lot because of POTS (and now chronic fatigue) so it's unsuprising that i've hurt my wrist. only, last week it was mega bad and i hadn't fallen on it for at least a week??? i waited for my physio appointment for advice, and was sent to get an x-ray that afternoon. i was told at the hospital that the x-ray showed no fracture, and i was sent away without any advice or aids (using a self-propelling wheelchair with a bad wrist isn't fun lol)

however just now my gp surgery called to say that there is an injury showing up on the x-ray - an old injury

so i've, like... broken my wrist at some point in the past and not known about it??

which is funny to me right now for some reason, probably because later i'll realise how fucked up that is

the ANP couldn't tell me how old the injury was so i have no idea when it happened. since the POTS got bad? that time i tripped over and fell when i was 13 and had a cast for a short time but it stopped hurting after the first 4 hours so no one ever looked at it again (was the even my left, or was it my right)? the time i hurt both my wrists when i was 11 falling playing football and my right was worse so i tried to write left-handed?? some other time i fell, it hurt, but i just got up and carried on like usual?

i'm autistic, and part of that for me is processing pain differently

i also have a genetic connective tissue disorder and have been in pain my whole life, but it's so normal that i rarely bothered to tell anyone when i was hurting because i didn't realise it wasn't supposed to happen (i decided, age 11, i'd just sprained my wrists, and got on with life as best i could for the following few painful days)

apparently it's not that unusual for the scaphoid (a wrist bone), some ribs, and a few bones in your foot and hand to go untreated

so like... idk if there's advice or anything here, other than... just because it doesn't 'hurt'... especially if you're autistic and/or have chronic pain