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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
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
Source
