Makindo Medical Notes.com

Always document Anatomical snuff box tenderness and request scaphoid views if present. If<14yrs obtain AP/Lateral of wrist only

About

• Scaphoid fractures are an important public health problem as they predominantly affect young active individuals in the more productive working years of their lives.
• Non-union, if untreated, can lead to arthritis which can disable patients at a very young age
• A fracture can alter the blood supply to the bone

Mechanism

• Fall on outstretched hand in
• Waist 65% proximal 25% distal 15%
• Skiing or snowboarding, or RTC

Clinical

• Wrist swelling rarely may have bruising and deformity
• Pain with resisted pronation and anatomic snuffbox tenderness dorsally
• scaphoid tubercle tenderness volarly
• scaphoid compression test positive test when pain reproduced with axial load applied through thumb metacarpal

Investigations

• Scaphoid views and 30% are negative
• MRI sensitive for occult fractures
• CT scan with 1mm cuts along scaphoid axis can help the diagnosis

Complications

• Delayed union
• Non-union
• Avascular necrosis
• Osteoarthritis

Management

• Diagnosis: a scaphoid fracture, especially when nondisplaced, may not be visible on X-rays in the early days after an injury, the wrist may be placed in a cast for ten days, and the patient may be asked to return for another set of X-ray. At this point, a healing fracture will characteristically become more visible on X-rays because the normal healing process leads to removal of some of the jagged edges of the broken bone, causing the fracture to appear wider.
• Non operative: cast immobilization and refer fracture clinic
• Operative: screw fixation or open reduction and fixation

References

• Scaphoid fracture
• Scaphoid Fractures and Nonunion: Wrist Fractures and Treatment