Difference between revisions of "Scaphoid fracture"
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*Most commonly fractured carpal bone | *Most commonly fractured carpal bone | ||
*Occurs via FOOSH or axial load directed along thumb's metacarpal | *Occurs via FOOSH or axial load directed along thumb's metacarpal | ||
| + | *Most common fracture at the waist of the scaphoid | ||
*Avascular necrosis | *Avascular necrosis | ||
| − | **Most commonly | + | **Most commonly associated with proximal fractures (blood supply enters the distal part of the bone) |
==Clinical Features== | ==Clinical Features== | ||
| + | [[File:Snuffbox2017.jpg|thumb|Anatomical snuff box]] | ||
*Pain along radial aspect of wrist | *Pain along radial aspect of wrist | ||
*Localized tenderness in anatomic snuffbox | *Localized tenderness in anatomic snuffbox | ||
*Pain elicited by axial pressure directed along thumb's metacarpal | *Pain elicited by axial pressure directed along thumb's metacarpal | ||
| − | == | + | ==Differential Diagnosis== |
| + | {{Carpal fractures}} | ||
| + | |||
| + | ==Evaluation== | ||
| + | [[File:Scaphoid waist fracture.gif|thumb|Scaphoid waist fracture]] | ||
| + | [[File:Scaphoid-Pseudarthrose1.jpg|thumb|Scaphoid pseudarthrosis, before and after treatment with Herbert screw.]] | ||
| + | ===Workup=== | ||
*X-ray | *X-ray | ||
**Obtain both standard and scaphoid views | **Obtain both standard and scaphoid views | ||
| − | **Up to 10% of initial radiographs fail to detect a | + | **Up to 10% of initial radiographs fail to detect a fracture |
*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 | ||
| − | == | + | ===Diagnosis=== |
| − | + | [[File:Scaphoid.jpg|thumb|Scaphoid fractures occur in three locations: (A) Distal tubercle, (B) waist, and (C) proximal pole.]] | |
| − | |||
| − | |||
| − | |||
*Assess for instability: | *Assess for instability: | ||
| − | **Oblique | + | **Oblique fracture |
**>1mm of displacement | **>1mm of displacement | ||
**Rotation | **Rotation | ||
**Comminution | **Comminution | ||
**Carpal instability pattern is present | **Carpal instability pattern is present | ||
| − | + | ||
| − | + | ==Management== | |
| − | + | ''All patients with clinical suspicion should be treated regardless of x-ray findings'' | |
| + | {{General Fracture Management}} | ||
| + | |||
| + | ===Immobilization=== | ||
| + | *Stable fracture: short-arm [[thumb spica splint]] in dorsiflexion and radial deviation | ||
| + | *Unstable fracture: long-arm [[thumb spica splint]] | ||
==Disposition== | ==Disposition== | ||
| − | *Refer to a hand surgeon | + | *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)<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> | *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> | ||
| + | *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== | ==See Also== | ||
*[[Carpal fractures]] | *[[Carpal fractures]] | ||
| − | == | + | ==References== |
| − | |||
| − | |||
<references/> | <references/> | ||
| − | [[Category: | + | [[Category:Orthopedics]] |
Latest revision as of 04:46, 18 September 2019
Contents
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
- Scaphoid fracture
- Lunate fracture
- Triquetrum fracture
- Pisiform fracture
- Trapezium fracture
- Trapezoid fracture
- Capitate fracture
- Hamate fracture
Evaluation
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
- 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
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Immobilization
- Stable fracture: short-arm thumb spica splint in dorsiflexion and radial deviation
- Unstable fracture: long-arm thumb spica splint
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
- ↑ 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.