Scaphoid fractures


Refers to a break of the scaphoid bone in the wrist.

It is the most common wrist bone fracture.

Males are affected more often than females.

Common in young males.

Scaphoid fractures account for 50%-80% of carpal injuries.

Symptoms of a scaphoid fracture includes:pain at the base of the thumb which is worse with use of the hand, and then anatomic snuffbox is generally tender and swelling may occur.

Complications of a scaphoid fracture may include nonunion of the fracture, avascular necrosis, and arthritis.

Types of fractures include: Proximal, medial (waist), and distal.

10%-20% of fractures are at the proximal pole, 60%-80% are at the waist (middle), and the remainder occur at the distal pole.

Caused by a fall on an outstretched hand.

Fractures can occur either with direct axial compression or with hyperextension of the wrist, such as a fall on the palm on an outstretched hand.

Diagnosis confirmed by physical examination, X-rays, MRI, and,bone scan.

They are often diagnosed by PA and lateral X-rays of the wrist.

Not all fractures are apparent initially: Patients with tenderness over the anatomic snuff box are often splinted for 7–10 days at which point a second set of X-rays is taken.

If suspicion for scaphoid fracture exists with negative X-rays, MRI or CT scans can provide better resolution, and a bone scan is also an effective method for diagnosis fracture which do not appear on X-ray.

Differential diagnosis includes: Distal radius fracture, De Quervain’s tenosynovitis, scapholunate dissociation, and wrist sprain.

Prevention includes the use of wrist guards.

Treatment of scaphoid fractures is based on variable factors: the location in the bone of the fracture being proximal, waist, or distal, displacement, or instability of the fracture, and the patient’s ability to tolerate cast immobilization.

In well aligned fractures a cast is generally adequate for healing

With displaced fractures surgery is generally recommended.

Non, or minimally, displaced waist and distal fractures have a high rate of union with cast management.

Generally, a short arm or short arm thumb spica cast is used for non displaced fractures.

Minimal incision surgery for non displaced or minimally displaced fractures has a high union rate, low morbidity and faster return to activity than cast management.

Fractures may take up to six months to heal.

Scaphoid fractures generally have snuff box tenderness.

Scaphoid fracture symptoms include: aching at the wrist, decreased range of motion of the wrist, and pain during activities.

The vascular supply of the scaphoid comes from two different sources.

20-30% of the blood supply comes from the volar branch of the radial artery, and 70-80% comes from the dorsal branch of the radial artery.

Avascular necrosis is a common complication of a scaphoid fracture, as it may be associated with limited access to blood supply.

Avascular necrosis (AVN) risk occurrence depends on the location of the fracture: Fractures in the proximal 1/3 have a high incidence of AVN at about 30%, fractures in the middle 1/3 is the most frequent fracture site and has moderate risk of AVN, and fractures in the distal 1/3 are rarely complicated by AVN.

If scaphoid fractures are undiagnosed or under treated, non-union can occur.

Non-union can lead to osteoarthritis.

Fractures at the proximal end are particularly at risk for non-union due to the tenuous blood supply.

Scaphoid fracture symptoms include: aching at the wrist, decreased range of motion of the wrist, and pain during activities.

Fracture healing: more proximal fractures take longer to heal, about 12–24 weeks.

Distal third fractures will heal in 6 to 8 weeks.

Middle third fractures will take 8–12 weeks.

The scaphoid bone receives its blood supply primarily from lateral and distal branches of the radial artery, and blood flows in a retrograde fashion down to the proximal pole, making fractures susceptible to nonunion.

Surgery may be required to mechanically mend the bone together.

Percutaneous screw fixation is recommended over a wide surgical approach as this method preserves the palmar ligament complex and local vasculature, and helps avoid postoperative complications.

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