Flashcards in Wrist & Hand: Scaphoid fractures Deck (16)
what is the most commonly fractured carpus?
how is the scaphoid bone divided?
branches of which artery supply the scaphoid bone?
radial artery - dorsal branch of the radial artery
where does the dorsal branch of the radial artery enter the scaphoid bone and what is the clinical significance of this?
distal pole and travels in a retrograde fashion towards the proximal pole. fractures can compromise the blood supply leading to avascular necrosis (AVN)
fractures where on the scaphoid bone are at higher risk of AVN?
the more proximal the fracture the higher the likelihood AVN
common mechanism of injury for scaphoid fracture
clinical features of scaphoid fractures
sudden wrist pain
may be bruising
tenderness in flood of anatomical snuffbox
pain on palpating scaphoid tubercle
pain on telescoping of the thumb
what is another differential for pain on telescoping of the thumb?
osteoarthritis of the 1st metacarpal base
DDx for scaphoid fractures
distal radius fracture
alternative carpal bone fracture
fracture of base of 1st metacarpal
ulnar collateral ligament injury
De Quervains tenosynovitis
what investigations are done for a ?scaphoid fracture?
plain radiograph - scaphoid series - AP, lateral and oblique views
is a fracture always detected on initial radiographs?
no - especially when they are undisplaced
if there is sufficient clinical suspicion patient should have wrist immobilised in a thumb splint and repeat plain radiographs in 10-14 days
what is done when the repeat imaging is negative but clinical findings are still in keeping with scaphoid fracture?
MRI scan of the wrist - definitive investigation
interim treatment is as for a fracture
how are undisplaced scaphoid fractures managed?
strict immobilisation in plaster with spica thumb splint
Undisplaced fractures of proximal pole have high risk of AVN and surgical treatment may be advocated - particularly if dominant hand of working-age patient
how are displaced fractures managed?
percutaneous variable-pitched screw placed across the fracture site to compress it
complications of scaphoid fractures
AVN - 30% of cases - especially proximal
non-union - failing to heal properly most commonly due to poor blood supply