Difference between revisions of "Scaphoid fracture"

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==Imaging==
 
==Imaging==
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[[File:Scaphoid waist fracture.gif|thumb|Scaphoid waist fracture]]
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[[File:Scaphoid-Pseudarthrose1.jpg|thumb|Scaphoid pseudarthrosis, before and after treatment with Herbert screw.]]
 
*X-ray
 
*X-ray
 
**Obtain both standard and scaphoid views
 
**Obtain both standard and scaphoid views

Revision as of 20:18, 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

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