Difference between revisions of "Scaphoid fracture"

(Management)
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[[File:Scaphoid waist fracture.gif|thumb|Scaphoid waist fracture]]
 
[[File:Scaphoid waist fracture.gif|thumb|Scaphoid waist fracture]]
 
[[File:Scaphoid-Pseudarthrose1.jpg|thumb|Scaphoid pseudarthrosis, before and after treatment with Herbert screw.]]
 
[[File:Scaphoid-Pseudarthrose1.jpg|thumb|Scaphoid pseudarthrosis, before and after treatment with Herbert screw.]]
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===Workup===
 
*X-ray
 
*X-ray
 
**Obtain both standard and scaphoid views
 
**Obtain both standard and scaphoid views
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**Gold-standard in cases in which high index of suspicion remains despite negative x-ray
 
**Gold-standard in cases in which high index of suspicion remains despite negative x-ray
  
==Management==
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===Diagnosis===
 
[[File:Scaphoid.jpg|thumb|Scaphoid fractures occur in three locations: (A) Distal tubercle, (B) waist, and (C) proximal pole.]]
 
[[File:Scaphoid.jpg|thumb|Scaphoid fractures occur in three locations: (A) Distal tubercle, (B) waist, and (C) proximal pole.]]
*All patients with clinical suspicion should be treated regardless of xray findings
 
 
*Assess for instability:
 
*Assess for instability:
 
**Oblique fracture
 
**Oblique fracture
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**Comminution
 
**Comminution
 
**Carpal instability pattern is present
 
**Carpal instability pattern is present
*Immobilize
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**Stable fracture: short-arm [[thumb spica splint]] in dorsiflexion and radial deviation
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==Management==
**Unstable fracture: long-arm [[thumb spica splint]]
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''All patients with clinical suspicion should be treated regardless of x-ray findings''
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{{General Fracture Management}}
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===Immobilization===
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*Stable fracture: short-arm [[thumb spica splint]] in dorsiflexion and radial deviation
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*Unstable fracture: long-arm [[thumb spica splint]]
  
 
==Disposition==
 
==Disposition==

Latest revision as of 04:46, 18 September 2019

Background

  • Most commonly fractured carpal bone
  • Occurs via FOOSH or axial load directed along thumb's metacarpal
  • Most common fracture at the waist of the scaphoid
  • Avascular necrosis
    • Most commonly associated with proximal fractures (blood supply enters the distal part of the bone)

Clinical Features

Anatomical snuff box
  • Pain along radial aspect of wrist
  • Localized tenderness in anatomic snuffbox
  • Pain elicited by axial pressure directed along thumb's metacarpal

Differential Diagnosis

Carpal fractures

AP view

Evaluation

Scaphoid waist fracture
Scaphoid pseudarthrosis, before and after treatment with Herbert screw.

Workup

  • X-ray
    • Obtain both standard and scaphoid views
    • Up to 10% of initial radiographs fail to detect a fracture
  • MRI
    • Gold-standard in cases in which high index of suspicion remains despite negative x-ray

Diagnosis

Scaphoid fractures occur in three locations: (A) Distal tubercle, (B) waist, and (C) proximal pole.
  • Assess for instability:
    • Oblique fracture
    • >1mm of displacement
    • Rotation
    • Comminution
    • Carpal instability pattern is present

Management

All patients with clinical suspicion should be treated regardless of x-ray findings

General Fracture Management

Immobilization

Disposition

  • Refer to a hand surgeon because may lead to osteonecrosis if not properly recognized/treated
  • 25% of those with initially neg xray will actually have a fracture (typically found on delay xray or other modality)[1]
  • Repeat Wrist and scaphoid X-rays should be obtained 2-3 weeks after initial injury to assess for fracture if suspicion is high.
  • Immobilization may be required for at least 6-12 wks

See Also

References

  1. Gemme S and Tubbs R. What Physical Examination Findings and Diagnostic Imaging Modalities Are Most Useful in the Diagnosis of Scaphoid Fractures? Annals of Emergency Medicine. 2015. 65(3):308-309.