Dr. UTSAV AGRAWAL

SCAPHOID FRACTURES

Derived from greek word ‘scaphos’ meaning boat

Boat or cashew shaped bone

Rule of 70 for scaphoid – Accounts for 70% of carpal fracturesOf these 70% occur at waist70% of scaphoid fractures unite70% of vascular supply is through dorsal

branch of radial artery

Boat or cashew shaped80% of bone covered by articular surface

expect tubercleLocated in a 45° plane to horizontal and vertical axes•

ANATOMY

Mechanism of Injury

Common in young adultsFall on outstretched handMechanism – Bending with compression dorsally and tension on palmar surface owing to forced dorsiflexion

Proper history about mechanism of injuryClinical examinationRadiographic evaluation – X-ray – PA view, lateral, Radial oblique, ulnar

oblique, Scaphoid view

MRI – 100% sensitivity even in 48 hrsTc 99 bone scans also have high sensitivity in

occult fractures

Diagnosis

Gilula's Lines

MRI

CLASSIFICATION

80 %

15%

5%

Time to union – 4-6 weeks

Time to union – 10-12 weeks

Time to union – 12-20 weeks

Type A Stable Acute fracture

A1 : Fracture through tuberosity

A2 : Incomplete fracture through waist

HERBERT AND FISHER CLASSIFICATION

Type BUnstable Acute Fractures

Type B1: Distal Oblique Fracture

Type B2: Complete Fracture of Waist

Type B3: Proximal Pole Fracture

Type B4: Transscaphoid-Perilunate

Fracture-Dislocation of Carpus

Type B5: Comminuted Fractures

Type C Delayed Union

Type DEstablished Nonunuion

Type D1: Fibrous Union

Type D2: Pseudarthrosis

Russe Classification

Prosser Classification

Type 1 – Tuberosity fracture

Type 2 - Distal intra-articular fracture

Type 3 – Osteochondral fracture

Occult Fractures – Colles cast for 4-6 weeksType A1 – Colles cast cast for 4-6 weeksType A2 – Below elbow cast in neutral

position cast c ast for 6-12 weeks in low demand patients

in other patients percutaneous screw fixation

A displaced fracture is defined as one with more than 1 mm of step-off or more than 60 degrees of SL or 15 degrees of lunato-capitate angulation as observed on either plain radiographs or CT scans.

TREATMENT OPTIONS

Percutaneous Herbert

ScrewFixation

Type B2 – Percutaneous screw fixation - in case reduction cannot be achieved, open

reduction and internal fixation - Cast required in case of asso. ligamentous

injuryIn case of hump-back deformity, bone-grafting

may be required

Hump-back deformity

Type B3 - closed or open reduction and screw fixation through dorsal approach

Approach to scaphoid

VOLAR APPROACH

Dorso-lateral approach

Visualization of the joint capsule

Ulnar deviate the hand to expose the scaphoid

Scaphoid Non-union

Type D1 – Open reduction and screw fixation with bone gafting- either from distal radius or iliac crest

Success – 60-95%Type D2 – Open reduction and internal

fixation with bone graft or vascularised bone graft – pronator quadratus

Russ Graft

Patial radial styloidectomy and pronator quadratus bone graft

CASE REPORT

POST OP

10 weeks

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