Scaphoid fracture

Revision as of 22:38, 17 November 2014 by Rossdonaldson1 (talk | contribs)

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
    • Stable fx: short-arm thumb spica splint in dorsiflexion and radial deviation
    • Unstable fx: long-arm thumb spica splint
  • Refer to a hand surgeon b/c may lead to osteonecrosis if not properly recognized/treated

See Also

Wrist Fracture

Source

  • Tintinalli