Scaphoid fracture - # clinic

Question 1

3 parts of scaphoid

Answer 1

• Proximal pole
• Waist
• Distal pole

Question 2

Blood supply scaphoid

Answer 2

• 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

Question 3

Examination findings scaphoid #

Answer 3

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

Question 4

Borders of anatomical snuffbox

Answer 4

• 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

Question 5

Contents snuffbox

Answer 5

• Radial artery
• Superficial radial nerve
• Cephalic vein

Question 6

Investigation scaphoid #

Answer 6

• 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

Question 7

Management scaphoid #

Answer 7

• 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)

Question 8

Complications of scaphoid #

Answer 8

• 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

Question 9

MOI

Answer 9

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

Question 10

Specific signs of scaphoid #

Answer 10

• 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