SYB 3 SYB 3

Marni ScheinerMarni Scheiner

Scaphoid FractureScaphoid Fracture

Most common type of wrist fracture Location: Radial aspect of the hand just

distal to the radius itself 65% at the waist 15% proximal pole 10% distal body Results mainly from a fall on an

outstretched arm proximal carpal row Fx > distal carpal row

Fx

http://ptclinic.com/medlibrary/images/v2/ScaphoidFracture.gif

Most common type of wrist fracture Location: Radial aspect of the hand just

distal to the radius itself 65% at the waist 15% proximal pole 10% distal body Results mainly from a fall on an

outstretched arm proximal carpal row Fx > distal carpal row

Fx

http://ptclinic.com/medlibrary/images/v2/ScaphoidFracture.gif

Scaphoid FractureScaphoid Fracture Mechanism of injury

fall on the outstretched arm with the wrist in dorsiflexion.

Symptoms/Exam Findings History of fall/trauma Pain localized to radial aspect of wrist (anatomic

snuffbox); increased with palpation Dorsoradial swelling ROM and grip strength reduced

Any tenderness in the snuffbox should be treated as a scaphoid fracture until proven otherwise

Mechanism of injury fall on the outstretched arm with the wrist in

dorsiflexion. Symptoms/Exam Findings

History of fall/trauma Pain localized to radial aspect of wrist (anatomic

snuffbox); increased with palpation Dorsoradial swelling ROM and grip strength reduced

Any tenderness in the snuffbox should be treated as a scaphoid fracture until proven otherwise

Scaphoid FractureScaphoid Fracture Radiographic Findings

Standard Radiographs PA, true lateral, and scaphoid view

Scaphoid View: PA with wrist in full pronation and ulnar deviation

Shows scaphoid in its most longitudinal axis; separates it on radiograph from shadows of the distal radius.

If questionable Fx alignment on plain radiographs, an MRI or CT scan should be obtained to correctly identify the amount of displacement

Radiographic Findings Standard Radiographs

PA, true lateral, and scaphoid view

Scaphoid View: PA with wrist in full pronation and ulnar deviation

Shows scaphoid in its most longitudinal axis; separates it on radiograph from shadows of the distal radius.

If questionable Fx alignment on plain radiographs, an MRI or CT scan should be obtained to correctly identify the amount of displacement

Scaphoid FractureScaphoid Fracture Should evaluate for signs of ligament

disruption (*esp scapholunate ligament).

"Terry Thomas” Sign Normal space b/w scaphoid and lunate

bones = 1-2mm Terry Thomas Sign

widened space (>3 mm) between the scaphoid and the lunate

accentuated in PA of closed hand in a fist with ulnar deviation

important since it is a cause of chronic wrist pain and disability if left untreated.

www.rcsed.ac.uk/.../hand/scapholunate_diss.htm

Should evaluate for signs of ligament disruption (*esp scapholunate ligament).

"Terry Thomas” Sign Normal space b/w scaphoid and lunate

bones = 1-2mm Terry Thomas Sign

widened space (>3 mm) between the scaphoid and the lunate

accentuated in PA of closed hand in a fist with ulnar deviation

important since it is a cause of chronic wrist pain and disability if left untreated.

www.rcsed.ac.uk/.../hand/scapholunate_diss.htm

Scaphoid FractureScaphoid Fracture Suspected fracture with negative plain

radiographs: If compressed or minimally displaced, initial

radiographs may be negative. Traditional approach:

immobilization followed by additional radiographs (7-10 days). CT/MRI

For definitive Dx in Pt can not tolerate any unnecessary immobilization (ex. a competitive athlete)

CT scan more readily available

MRI less costly More information about ligamentous or other possible injuries

Suspected fracture with negative plain radiographs: If compressed or minimally displaced, initial

radiographs may be negative. Traditional approach:

immobilization followed by additional radiographs (7-10 days). CT/MRI

For definitive Dx in Pt can not tolerate any unnecessary immobilization (ex. a competitive athlete)

CT scan more readily available

MRI less costly More information about ligamentous or other possible injuries

Scaphoid FractureScaphoid Fracture Complications

Malunion

Delayed Union

Nonunion

*AVASCULAR NECROSIS (AVN) Osteonecrosis is more common in scaphoid Fx’s than most

other bones; 15-30% of all scaphoid fractures most commonly involves the proximal pole blood supply runs from distal to proximal leading to the

possibility of non-union or osteonecrosis of the proximal pole

Complications Malunion

Delayed Union

Nonunion

*AVASCULAR NECROSIS (AVN) Osteonecrosis is more common in scaphoid Fx’s than most

other bones; 15-30% of all scaphoid fractures most commonly involves the proximal pole blood supply runs from distal to proximal leading to the

possibility of non-union or osteonecrosis of the proximal pole

Scaphoid FractureScaphoid Fracture Treatment

If Fx displaced (≥ 1 mm) and/or significantly increased or decreased scapholunate angle

immobilize in a thumb spica splint and referred for orthopedic evaluation.

Non-displaced fractures (<1 mm) short-arm thumb-spica cast typically for six to 10 weeks.

Fractures at the waist or proximal third could be given more substantial immobilization in a long-arm cast.

If immobilization is not an option, operative fixation is suggested.

Athletes: rigid protection for 2 months after radiographic healing.

Treatment If Fx displaced (≥ 1 mm) and/or significantly increased or

decreased scapholunate angle immobilize in a thumb spica splint and referred for orthopedic

evaluation.

Non-displaced fractures (<1 mm) short-arm thumb-spica cast typically for six to 10 weeks.

Fractures at the waist or proximal third could be given more substantial immobilization in a long-arm cast.

If immobilization is not an option, operative fixation is suggested.

Athletes: rigid protection for 2 months after radiographic healing.