Scaphoid bone fracture

Question 1

What are the causes of scaphoid fracture?

Answer 1

• FOOSH

- Contact sports

Question 2

How do patients with scaphoid fracture typically present?

Answer 2

• Pain along radial aspect of wrist, at base of thumb
• Loss of grip strength
• Painful/weakened pinching and grasping

Question 3

What are the clinical signs of scaphoid fracture?

Answer 3

1. Point of maximal tenderness over anatomical snuffbox
   - highly sensitive but poorly specific
2. Wrist joint effusion
3. Pain elicited by telescoping the thumb (longitudinal compression)
4. Pain on ulnar deviation of the wrist

Question 4

What is 1st-line imaging for a suspected scaphoid fracture?

Answer 4

Plain film radiograph (x-ray). Order:

• posterioranterior (PA)
• lateral
• oblique
• Ziter views (PA view with wrist in ulnar deviation)

Question 5

Which imaging modality is considered definitive for confirming scaphoid fracture?

Answer 5

MRI

Question 6

What is the initial management of suspected or confirmed scaphoid fracture? (i.e. if someone presented to GP)

Answer 6

• immobilisation with futuro splint or standard below-elbow backslab
• referral to orthopaedics –> clinical review with further imaging within 7-10 days

Question 7

How are scaphoid fractures managed with the orthopaedic department?

Answer 7

1. Undisplaced:
   - cast for 6-8 weeks
   - union is achieved in >95%
2. Displaced:
   - surgical fixation
3. Proximal scaphoid pole fractures:
   - surgical fixation

Question 8

Why is it important to recognise and treat scaphoid fractures early?

Answer 8

• Unusual blood supply increases risk of avascular necrosis

- can lead to long-term impairment

Question 9

Which neurovascular structure is most likely to be compromised in scaphoid fractures?

Answer 9

Dorsal carpal arch of the radial artery