3 two months after the first radiograph, when he presented with persistent wrist pain. The arrow indicates the fracture. buy viagra fast shipping The fractured scaphoid exhibits certain behavior that inhibits healing. Fracture fragments are inherently unstable and prone to displacement, and require motionless contact to achieve union. cheapest viagra prices 15 as mentioned before, the blood supply of the scaphoid is tenuous. For therapeutic decision making, the scaphoid is divided into three anatomic sections: proximal, medial, and distal. safe 19 year old take viagra Fractures are further subdivided into displaced and non-displaced types. safe 19 year old take viagra Nondisplaced fractures nondisplaced distal fractures heal well with strict immobilization in a well-molded short arm thumb spica. buy viagra cheap Controversy exists over whether to use a long arm or a short arm cast. One comparison16 found that nondisplaced fractures healed well regardless of the type of cast that was used. Current treatment for this type of fracture is a thumb spica, but some evidence suggests that the thumb could be omitted from the cast. A randomized prospective trial17 found that immobilization of the thumb did not improve outcomes for nondisplaced fractures. Screw fixation may speed recovery to pre-injury activities; referral for surgery may be indicated, depending on the needs of the patient. 18 as the fracture line moves proximally, there is more risk of displacement and nonunion; therefore, it would be appropriate to refer these patients for orthopedic consultation. cheap viagra If conservative treatment is attempted, a long arm cast with thumb immobilization is appropriate. Displaced fractures fractures with even small amounts of displacement are prone to nonunion, and operative treatment is recommended. 19 splinting and referral are indicated. The authors t. Grant phillips, m. generic viagra canada D. , is assistant director of the washington hospital family practice residency in washington, pa. He received his medical degree from hahnemann medical college in philadelphia, and after a one-year surgical internship, completed a residency in family practice at the wyoming valley family practice residency program in kingston, pa. Andrew m. Reibach, m. D. viagra pills , is assistant director of the washington hospital family practice residency. He received his medical degree from the university of texas southwestern medical center at dallas and completed a residency at southern colorado family medicine in pueblo, co. Dr. Reibach holds a certificate of added qualification in adolescent medicine. buy cheap viagra next day delivery W. Paul slomiany, m. buy viagra canada D. , is assistant director of the washington hospital family practice residency. He received his medical degree from temple university school of medicine in philadelphia and completed a residency at the washington hospital, washington, pa. safe 19 year old take viagra He is a di.