Scaphoid fracture

Revision as of 16:53, 24 February 2015 by Neil.m.young (talk | contribs) (dispo section added)

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.