Difference between revisions of "Scaphoid fracture"

m (Rossdonaldson1 moved page Scaphoid Fracture to Scaphoid fracture)
(Management)
Line 28: Line 28:
 
**Carpal instability pattern is present
 
**Carpal instability pattern is present
 
*Immobilize
 
*Immobilize
**Stable fx: short-arm thumb spica splint in dorsiflexion and radial deviation
+
**Stable fracture: short-arm [[thumb spica splint]] in dorsiflexion and radial deviation
**Unstable fx: long-arm thumb spica splint
+
**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

AP view

Management

  • Assess for instability:
    • Oblique fx
    • >1mm of displacement
    • Rotation
    • Comminution
    • Carpal instability pattern is present
  • Immobilize
  • Refer to a hand surgeon b/c may lead to osteonecrosis if not properly recognized/treated

See Also

Wrist Fracture

Source

  • Tintinalli