Difference between revisions of "Scaphoid fracture"

(all people treated with suspicion)
(dispo section added)
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**Stable fracture: short-arm [[thumb spica splint]] in dorsiflexion and radial deviation
 
**Stable fracture: short-arm [[thumb spica splint]] in dorsiflexion and radial deviation
 
**Unstable fracture: long-arm [[thumb spica splint]]
 
**Unstable fracture: long-arm [[thumb spica splint]]
 +
 +
==Disposition==
 
*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
 +
*25% of those with initially neg xray will actually have a fracture (typically found on delay xray or other modality)<ref>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.</ref>
  
 
==See Also==
 
==See Also==

Revision as of 16:53, 24 February 2015

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

  • All patients with clinical suspicion should be treated regardless of xray findings
  • Assess for instability:
    • Oblique fx
    • >1mm of displacement
    • Rotation
    • Comminution
    • Carpal instability pattern is present
  • Immobilize

Disposition

  • Refer to a hand surgeon b/c 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]

See Also

Source

  • Tintinalli
  • 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.