Scaphoid fracture: Difference between revisions
m (Rossdonaldson1 moved page Scaphoid Fracture to Scaphoid fracture) |
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**Carpal instability pattern is present | **Carpal instability pattern is present | ||
*Immobilize | *Immobilize | ||
**Stable | **Stable fracture: short-arm [[thumb spica splint]] in dorsiflexion and radial deviation | ||
**Unstable | **Unstable fracture: long-arm [[thumb spica splint]] | ||
*Refer to a hand surgeon b/c may lead to osteonecrosis if not properly recognized/treated | *Refer to a hand surgeon b/c may lead to osteonecrosis if not properly recognized/treated | ||
Revision as of 11:51, 18 November 2014
Background
- Most commonly fractured carpal bone
- Occurs via FOOSH or axial load directed along thumb's metacarpal
- Avascular necrosis
- Most commonly a/w proximal fractures (blood supply enters the distal part of the bone)
Clinical Features
- Pain along radial aspect of wrist
- Localized tenderness in anatomic snuffbox
- Pain elicited by axial pressure directed along thumb's metacarpal
Imaging
- X-ray
- Obtain both standard and scaphoid views
- Up to 10% of initial radiographs fail to detect a fx
- MRI
- Gold-standard in cases in which high index of suspicion remains despite negative x-ray
Differential Diagnosis
Carpal fractures
- Scaphoid fracture
- Lunate fracture
- Triquetrum fracture
- Pisiform fracture
- Trapezium fracture
- Trapezoid fracture
- Capitate fracture
- Hamate fracture
Management
- Assess for instability:
- Oblique fx
- >1mm of displacement
- Rotation
- Comminution
- Carpal instability pattern is present
- Immobilize
- Stable fracture: short-arm thumb spica splint in dorsiflexion and radial deviation
- Unstable fracture: long-arm thumb spica splint
- Refer to a hand surgeon b/c may lead to osteonecrosis if not properly recognized/treated
See Also
Source
- Tintinalli