Difference between revisions of "Scaphoid fracture"

(Text replacement - "Category:Ortho" to "Category:Orthopedics")
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*Pain elicited by axial pressure directed along thumb's metacarpal
 
*Pain elicited by axial pressure directed along thumb's metacarpal
  
==Imaging==
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==Differential Diagnosis==
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{{Carpal fractures}}
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 +
==Diagnosis==
 
[[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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*MRI
 
*MRI
 
**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
 
==Differential Diagnosis==
 
{{Carpal fractures}}
 
  
 
==Management==
 
==Management==
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*[[Carpal fractures]]
 
*[[Carpal fractures]]
  
==Source==
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==References==
 
<references/>
 
<references/>
 
*Williams DT, Kim HT: Wrist and Forearm; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 51: p 570-597.
 
*Williams DT, Kim HT: Wrist and Forearm; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 51: p 570-597.

Revision as of 06:20, 10 May 2016

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

  • 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

Diagnosis

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

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 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.
  • Williams DT, Kim HT: Wrist and Forearm; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 51: p 570-597.
  • Cicero, M.: Scaphoid Fracture in Fleisher and Ludwig's 5-Minute Pediatric Emergency Consult, Lippincott, Williams and Wilkins 2012 pages 404-405