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Scaphoid fracture
From WikEM
Contents
Background
- Most commonly fractured carpal bone
- Occurs via FOOSH or axial load directed along thumb's metacarpal
- Most common fracture at the waist of the scaphoid
- Avascular necrosis
- Most commonly associated with proximal fractures (blood supply enters the distal part of the bone)
Clinical Features
- Pain along radial aspect of wrist
- Localized tenderness in anatomic snuffbox
- Pain elicited by axial pressure directed along thumb's metacarpal
Differential Diagnosis
Carpal fractures
- Scaphoid fracture
- Triquetrum fracture
- Lunate fracture
- Trapezium fracture
- Pisiform fracture
- Hamate fracture
- Capitate fracture
- Trapezoid fracture
Evaluation
- X-ray
- Obtain both standard and scaphoid views
- Up to 10% of initial radiographs fail to detect a fracture
- MRI
- Gold-standard in cases in which high index of suspicion remains despite negative x-ray
Management
- All patients with clinical suspicion should be treated regardless of xray findings
- Assess for instability:
- Oblique fracture
- >1mm of displacement
- Rotation
- Comminution
- Carpal instability pattern is present
- Immobilize
- Stable fracture: short-arm thumb spica splint in dorsiflexion and radial deviation
- Unstable fracture: long-arm thumb spica splint
Disposition
- Refer to a hand surgeon because may lead to osteonecrosis if not properly recognized/treated
- 25% of those with initially neg xray will actually have a fracture (typically found on delay xray or other modality)[1]
- Repeat Wrist and scaphoid X-rays should be obtained 2-3 weeks after initial injury to assess for fracture if suspicion is high.
- Immobilization may be required for at least 6-12 wks
See Also
References
- ↑ Gemme S and Tubbs R. What Physical Examination Findings and Diagnostic Imaging Modalities Are Most Useful in the Diagnosis of Scaphoid Fractures? Annals of Emergency Medicine. 2015. 65(3):308-309.
- Williams DT, Kim HT: Wrist and Forearm; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 51: p 570-597.
- Cicero, M.: Scaphoid Fracture in Fleisher and Ludwig's 5-Minute Pediatric Emergency Consult, Lippincott, Williams and Wilkins 2012 pages 404-405
