SCAPHOID FRACTURES

Question 1

The scaphoid accounts for 60% to 70% of all carpal fractures

Answer 1

t

Question 2

Their incidence occurs in men between the ages
of 15 and 19 years

Answer 2

T

Question 3

75% to 80% of scaphoid fractures occur at the waist, 10% to 15%
occur at the proximal pole, and 5% to 10% occur distally

Answer 3

T

Question 4

greater than 70% of the scaphoid’s
intraosseous vascularity from the dorsal scaphoid branches of the radial artery

Answer 4

T

Question 5

A minor volar contribution comes
from the radial artery or its superficial palmar branch.

Answer 5

T

Question 6

20% of patients with negative radiographs have
an occult acute fracture

Answer 6

T

Question 7

MRI is the most sensitive
and specific imaging modality for diagnosing scaphoid fractures and
also allows assessment of osseous blood supply and soft tissue injuries

Answer 7

T

Question 8

Computed tomography (CT) scan reformatted in the long axis
of the scaphoid is slightly less sensitive and specific for identification
of scaphoid fracture, but has the advantage of superior bony detail.

Answer 8

T

Question 9

Indication of surgical intervention in scaphoid fracture

Answer 9

■ Greater than 1 mm ofdisplacement at the waist
■ Lateral intrascaphoid angle >35°
■ Bone loss or comminution
■ Dorsal intercalated segment instability
■ Malalignment
■ Any proximal pole fracture

Question 10

Delayed presentation is also a relative indication for surgery

Answer 10

t

Question 11

Nonoperative treatment is reserved for nondisplaced scaphoid waist
and distal pole fractures

Answer 11

T

Question 12

For how long the immobilization of scaphiod fracture should stay?

Answer 12

Distal pole and tubercle fractures generally
require only 6 to 8 weeks to heal
scaphoid waist fractures usually require 12 weeks

Question 13

Immobilization can be discontinued when
bony union has been demonstrated

Answer 13

T

Question 14

We advocate CT scan to confirm
healing between 10 and 12 weeks,

Answer 14

T

Question 15

headless compression screws, revolutionizing the treatment of
scaphoid fractures

Answer 15

T

Question 16

When there is bone loss or comminution, cancellous or corticocancellous autogenous bone graft from the distal
radius can be used to fill the void and aid in healing

Answer 16

T

Question 17

proximal pole fractures
are more easily visualized using a dorsal approach

Answer 17

T

Question 18

distal
pole fractures are amenable to a volar approach

Answer 18

T

Question 19

benefit and draw back of the volar approach

Answer 19

provides wide bony exposure,
facilitates correction of a humpback deformity using structural bone graft
the volar margin of the trapezium hinders retrograde screw placement

Question 20

benefit and draw back of the dorsal approach

Answer 20

provides an unobstructed path for screw
placement, but exposure is more limited, and bone grafting for correction of a humpback deformity is more difficult from the dorsal approach. , the dorsal location of the dominant blood supply is at risk with distal exposure.

Question 21

Progressive wrist range of motion and strengtheningis
initiated following bony union.

Answer 21

t

Question 22

incidence of nonunion is approximately 10%

Answer 22

T

Question 23

The incidence of nonunion increases with

Answer 23

delayed presentation, fracture comminution, smoking, incomplete immobilization, or errors in surgical technique

Question 24

humpback deformity is present, a volar approach is recommended
such that the scaphoid can be extended and then held in alignment
with corticocancellous autogenous bone graft

Answer 24

T

Question 25

When nonunion is present in the absence of scaphoid flexion,
screw fixation and autogenous distal radius cancellous bone grafting
can be performed via a dorsal or volar approach

Answer 25

T

Question 26

Option of free vascularised bone graft

Answer 26

The 1,2 intercompartmental supra retinacular artery (l,2 ICSRA) flap
the medial femoral condyle free flap

Question 27

In proximal pole nonunion in yung patinets ?

Answer 27

replacement of the entire proximal pole including the proximal articular surface may be indicated.
Options include nonvascularized osteochondral rib graft and a
vascularized free medial femoral trochlea osteochondral free flap

Question 28

In patients who are older and have low functional
demand and in those who have developed arthritis of the radio scaphoid joint or irreducible flexion of the distal scaphoid fragment what is the option ?

Answer 28

salvage options such as proximal row corpectomy or limited intercarpal fusion are recommended

Question 29

The triquetrum is the second most common carpal fracture

Answer 29

t

Question 30

Because ofthe scaphoid’s retrograde vascular supply, distal
pole and tubercle fractures have a low incidence ofnonunion and can
generally be treated nonoperatively.

Answer 30

t

Question 31

Waist fractures can
be addressed from either side

Answer 31

T

Question 32

Treatment
principles for scaphoid waist nonunion include debridement and
reduction of the fracture if necessary, rigid fixation, and bone grafting

Answer 32

T

Question 33

When nonunion is present in the absence of scaphoid flexion,
screw fixation and autogenous distal radius cancellous bone grafting
can be performed via a dorsal or volar approach

Answer 33

T