Self-Inflicted Wrist Injuries Masquerading as Scaphoid Fractures in Military Recruits: Case Series
Assaf Kadar, MD; Gilad Eisnberg, MD; Haggai Sherman, MD; Dani Rotman, MD; Yishai Rosenblatt, MD; Tamir Pritsch, MD
Tel Aviv Medical Center, Tel Aviv, Israel
Aims We set out to investigate clinical characteristics resembling those found in scaphoid fractures but suspected as self-inflicted trauma for the purposes of secondary gain among young military recruits.
Methods In this retrospective case series study, 5 male soldiers with low motivation to serve in the military presented with snuffbox tenderness and pain. Each had a history of multiple encounters with their military unit's primary care physician for various complaints, most of which were not validated by the findings of objective diagnostic evaluations.
Results All the injuries of the 5 recruits resembled scaphoid fractures on physical examination. Several recurrent background characteristics, however, raised the suspicion that they had been self-inflicted: low motivation to serve in the military, multiple somatic complaints without corroborating physical or radiographic findings, description of injury occurrence inconsistent with the nature of the injury, exaggeration of the wrist pain and of the inability to move the wrist, and the possibility of secondary gain if the diagnosis were medically confirmed. A complete workup that included physical examination and imaging studies revealed swelling and tenderness in the snuffbox but no evidence of fracture.
Conclusions We describe radial wrist injury masquerading as a scaphoid fracture in young recruits who were apparently motivated by secondary gains. A raised level of suspicion in a setting of potential profit together with thorough physical and imaging evaluations are warranted to avoid unjustified intervention with potentially deleterious effects.
Fig. A 19-year-old soldier with suspected self-inflicted injury to the radial dorsal wrist. There is diffuse swelling and redness over the anatomical snuffbox and the first dorsal web.
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