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SYB 3

SYB 3 . Marni Scheiner. Scaphoid Fracture. Most common type of wrist fracture Location: Radial aspect of the hand just distal to the radius itself 65% at the waist 15% proximal pole 10% distal body Results mainly from a fall on an outstretched arm

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SYB 3

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  1. SYB 3 Marni Scheiner

  2. Scaphoid Fracture • Most common type of wrist fracture • Location: Radial aspect of the hand just distal to the radius itself • 65% at the waist • 15% proximal pole • 10% distal body • Results mainly from a fall on an outstretched arm • proximal carpal row Fx > distal carpal row Fx • http://ptclinic.com/medlibrary/images/v2/ScaphoidFracture.gif

  3. Scaphoid Fracture • Mechanism of injury • fall on the outstretched arm with the wrist in dorsiflexion. • Symptoms/Exam Findings • History of fall/trauma • Pain localized to radial aspect of wrist (anatomic snuffbox); increased with palpation • Dorsoradial swelling • ROM and grip strength reduced • Any tenderness in the snuffbox should be treated as a scaphoid fracture until proven otherwise

  4. Scaphoid Fracture • Radiographic Findings • Standard Radiographs • PA, true lateral, and scaphoid view • Scaphoid View: PA with wrist in full pronation and ulnar deviation • Shows scaphoid in its most longitudinal axis; separates it on radiograph from shadows of the distal radius. • If questionable Fx alignment on plain radiographs, an MRI or CT scan should be obtained to correctly identify the amount of displacement

  5. Scaphoid Fracture • Should evaluate for signs of ligament disruption (*esp scapholunate ligament). • "Terry Thomas” Sign • Normal space b/w scaphoid and lunate bones = 1-2mm • Terry Thomas Sign • widened space (>3 mm) between the scaphoid and the lunate • accentuated in PA of closed hand in a fist with ulnar deviation • important since it is a cause of chronic wrist pain and disability if left untreated. www.rcsed.ac.uk/.../hand/scapholunate_diss.htm

  6. Scaphoid Fracture • Suspected fracture with negative plain radiographs: • If compressed or minimally displaced, initial radiographs may be negative. • Traditional approach: • immobilization followed by additional radiographs (7-10 days). • CT/MRI • For definitive Dx in Pt can not tolerate any unnecessary immobilization (ex. a competitive athlete) • CT scan • more readily available • MRI • less costly • More information about ligamentous or other possible injuries

  7. Scaphoid Fracture • Complications • Malunion • Delayed Union • Nonunion • *AVASCULAR NECROSIS (AVN) • Osteonecrosis is more common in scaphoid Fx’s than most other bones; 15-30% of all scaphoid fractures • most commonly involves the proximal pole • blood supply runs from distal to proximal leading to the possibility of non-union or osteonecrosis of the proximal pole

  8. Scaphoid Fracture • Treatment • If Fx displaced (≥ 1 mm) and/or significantly increased or decreased scapholunate angle • immobilize in a thumb spica splint and referred for orthopedic evaluation. • Non-displaced fractures (<1 mm) • short-arm thumb-spica cast typically for six to 10 weeks. Fractures at the waist or proximal third could be given more substantial immobilization in a long-arm cast. • If immobilization is not an option, operative fixation is suggested. • Athletes: rigid protection for 2 months after radiographic healing.

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