Scaphoid fracture - # clinic Flashcards

1
Q

3 parts of scaphoid

A
  • Proximal pole
  • Waist
  • Distal pole
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2
Q

Blood supply scaphoid

A
  • Branches of radial artery
  • Blood enters distal pole and supplies via retrograde flow
  • # can compromise blood supply to proximal scaphoid = AVN
  • More proximal = more risk of AVN
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3
Q

Examination findings scaphoid #

A
  • Anatomical snuffbox tenderness
  • Radial wrist aspect tenderness
  • Pain on palpation of scaphoid tubercle (palmar side, thenar eminence)
  • Pain on telescoping thumb
  • Loss grip strength
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4
Q

Borders of anatomical snuffbox

A
  • Lateral/ulnar - abductor pollicis longus, extensor pollicis brevis
  • Medial/radial - extensor pollicis longus

Floor = scaphoid, trapezium and radial styloid

Remember this is in anatomical position

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5
Q

Contents snuffbox

A
  • Radial artery
  • Superficial radial nerve
  • Cephalic vein
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6
Q

Investigation scaphoid #

A
  • x-ray scaphoid series - PA, lateral and oblique
  • Not always detected - if not immobilise and repeat x-ray in 10-14 days
  • If STILL -ve and clinical findings still suggest # - MRI scan of wrist
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7
Q

Management scaphoid #

A
  • Undisplaced - strict immbolisation in plaster with thumb spica splint (or futuro or below elbow backslab)
  • Undisplaced involving proximal pole - high risk of AVN, may need surgery esp if dominant working hand
  • Displaced - fixed with surgery, percutaneous variable pitch screw is common (place across # site to compress)
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8
Q

Complications of scaphoid #

A
  • AVN - risk increases more proximal the # is
  • Non union - failure of bone to heal properly, commonly due to poor blood supply - can manage with internal fixation and bone grafts –> pain and early OA
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9
Q

MOI

A
  • FOOSH
  • Common in autumn - contact sports peak eg rugby season
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10
Q

Specific signs of scaphoid #

A
  • Maximal tenderness over anatomical snuffbox
  • Wrist joint effusion - hyperacute and delayed may not have this
  • Pain elicited by telescoping thumb
  • Tenderness scaphoid tubercle (volar side)
  • Pain on ulnar deviation of wrist
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11
Q
A
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