We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Scaphoid Fracture

From WikiSM
Jump to: navigation, search

Other Names

  • Scaphoid non union

Background

  • This page refers to fractures of the Scaphoid bone

History

Epidemiology

  • Scaphoid is most commonly fractured carpal bone (need citation)
  • 10% of all hand fractures and 60% of all carpal fractures (need citation)
  • 15% of wrist fractures (need citation)
  • Males > females

Pathophysiology

  • General
    • Proximal 80% of scaphoid receives retrograde blood flow from dorsal carpal branch of the radial artery
    • Distal 20% receives blood supply from superficial palmar arch
    • Retrograde blood supply makes scaphoid particular susceptible to avascular necrosis and nonunion
  • Location (need citation)
    • 65% occur in the waist
    • 25% proximal 1/3rd
    • 10% distal 1/3rd

Etiology

  • Traumatic injury which typically involves fall on outstretched hand
    • Wrist is hyper-extended with radial deviation

Risk Factors

  • Needs to be updated

Differential Diagnosis

Carpal Bone Fractures

Differential Diagnosis Wrist Pain

Clinical Features

  • History
    • Patients will some history of trauma
    • Will complain of wrist pain or thumb pain, worse with movement or activity
  • Physical Exam: Physical Exam Wrist
    • These 3 exam findings reported to be 100% sensitive, 74% specific for scaphoid fracture in first 24 hours following injury[1]
      • Scaphoid compression test
      • Snuffbox tenderness
      • Palpation of the volar scaphoid tubercle
    • Pain with resisted pronation
  • Special Tests
    • Scaphoid Shift Test: apply pressure to scaphoid with ulnar and radial deviation
    • Clamp Sign: Patient will form a clamp with the opposite thumb and index finger over scaphoid

Evaluation

  • Possible scaphoid fracture with subtle lucency in the waist

  • Chronic scaphoid fracture with severe degenerative changes

  • CT of chronic scaphoid fracture with nonunion

Radiographs

  • Standard Radiographs Wrist
  • 3 view radiographs often sufficient
  • Scaphoid view: PA view in ulnar deviation
  • If negative but suspicious, repeat in 2-3 weeks

MRI

  • Most sensitive for occult fractures
  • Can evaluate for other soft tissue pathology

CT

  • Useful for assessing fracture fragments, extend of collapse, pre-operative planning

Bone scan

  • Falling out of favor, remains an option

Classification

Herbert and Fisher's Classification of Scaphoid Fractures

  • Type A: Stable acute fractures
    • A1: Tubercle fracture
    • A2: Incomplete waist fracture
  • Type B: Unstable acute fractures
    • B1: Distal oblique fractures
    • B2: Complete or displaced waist fracture
    • B3: Proximal pole fracture
    • B4: Transscaphoid perilunate dislocation fracture
    • B5: Comminuted fracture
  • Type C: Delayed union
  • Type D: Established nonunion
    • D1: Fibrous union
    • D2: Pseudoarthrosis

Management

Prognosis

  • Nonoperative
    • >90% of union in scaphoid fractures with <1 mm displacement (need citation)

Nonoperative

  • Indications
    • Stable, nondisplaced (majority)
    • Normal radiographs with high index of suspicion

Suspected Fracture

  • In patients with normal radiographs, but a high degree of clinical suspicion,
  • Patients should be placed in a thumb spica splint with repeat radiographs in roughly 1-2 weeks

Confirmed Fracture

  • Management decisions should be made in consultation with an orthopedic surgeon
  • The majority of scaphoid fractures are nondisplaced or minimally displaced
  • Can be treated with immobilization for 8-12 weeks in a thumb spica cast

Operative

  • Indications
    • Unstable fractures: proximal pole, >1 mm displacement
    • Displaced waist and proximal pole scaphoid fractures
    • High risk of delayed union, nonunion, or avascular necrosis
  • Technique
    • Percutaneus screw fixation
    • Open reduction, internal fixation

Rehab and Return to Play

Rehabilitation

Return to Play

  • Dictated by physician
  • Minimum 6 weeks

Complications

See Also

References

  1. ↑ Parvizi J, Wayman J, Kelly P, Moran CG. Combining the clinical signs improves diagnosis of scaphoid fractures. A prospective study with follow-up. J Hand Surg Br. 1998 Jun; 23(3):324-7
Created by:
John Kiel on 10 June 2019 01:01:55
Last edited:
13 October 2022 21:41:41
Categories:
Trauma | Osteology | Wrist | Upper Extremity | Fractures | Acute

Retrieved from "https://wikism.org/w/index.php?title=Scaphoid_Fracture&oldid=18123"