Hand - carpal fractures

Question 1

Which carpal bones are more susceptible to AVN after trauma?

Answer 1

scaphoid, lunate, capitate

They each have a large area supplied by a single interosseous vessel

Question 2

Indications for operative treatment for scaphoid fractures (6)

Answer 2

1. proximal pole fracture
2. > 1mm displacement
3. intrascaphoid angle >35 degrees (humpback deformity)
4. comminuted or vertical/oblique fracture
5. transscaphoid perilunate dislocation

Question 3

What is the most critical technical factor in ORIF for scaphoid fractures?

Answer 3

Guide pin placement should be within the central axes of both the proximal and distal fragments

Question 4

when do you need to use vascularized bone graft in scaphoid nonunions?

Answer 4

When there is an avascular proximal pole

Question 5

What is the natural sequelae of scaphoid nonunion if not treated?

Answer 5

SNAC wrist: Scaphoid nonunion advanced collapse
Progression:
1. stage 1 - radioscaphoid arthitis
2. stage 2 - involvement of the scaphocapitiate joint
3. involvement of the lunocapitate joint