Scaphoid Fractures

Question 1

What is a scaphoid fracture?

Answer 1

It is defined as a wrist fracture involving the scaphoid carpal bone

Question 2

What is the most commonly fracture carpal bone?

Answer 2

Scaphoid

Question 3

What is the mechanism of injury associated with scaphoid fractures?

Answer 3

A fall on an ulnar deviated, pronated and hyperdorsifexed (outstretched) wrist

Question 4

What three risk factors are associated with scaphoid fractures?

Answer 4

Young Age, 15 – 29 Years Old

Male Gender

Contact Sports

Question 5

What are the four clincial features of scaphoid fractures?

Answer 5

Deep Dull Radial Wrist Pain

Wrist Joint Effusion

Decreased Wrist Movement

Decreased Grip/Pinch Strength

Question 6

Describe the pain associated with scaphoid fractures

Answer 6

The pain is located in the anatomical snuffbox dorsally or scaphoid tubercle volarly

The pain is elicted by telescoping of the thumb, which is longitudinal compression

Question 7

Where is the anatomical snuffbox located?

Answer 7

It is located between the extensor pollicis longus and the extensor pollicis brevis tendons

Question 8

What two investigations are used to diagnose scaphoid fractures?

Answer 8

Wrist X-Ray

MRI Scans

Question 9

Which four x-ray views should be requested in order to diagnose scaphoid fractures?

Answer 9

Anterior-Posterior View

Lateral View

Oblique View

Scaphoid View

Question 10

What two features indicate scaphoid fractures on wrist x-rays?

Answer 10

Lucent Line Of Scaphoid

Wrist Soft Tissue Swelling

Question 11

What is important to note about the use of wrist x-rays in order to diagnsoe scaphoid fractures?

Answer 11

The initial wrist x-ray scan may result in the presentation of normal results

Therefore, diagnosis should not be excluded until further imaging is conducted

Question 12

What is the gold standard investigation used to diagnose scaphoid fractures?

Answer 12

MRI Scans

Question 13

What is the feature of scaphoid fractures on MRI scans?

Answer 13

Scaphoid bone signal changes

Question 14

What is the most appropriate management step in cases of suspected scaphoid fractures, with inconclusive imaging?

Answer 14

There should be further imaging and a clinical review 7 – 10 days after injury

Question 15

What are the three immediate management options of scaphoid fractures?

Answer 15

ABCDE Assessment

Analgesia

Wrist Immobilisation

Question 16

What two splints are used to immediatley immobilise scaphoid fractures?

Answer 16

Futuro splint

Standard below-elbow backslab

Question 17

What is the non-surgical management option of scaphoid fractures?

Answer 17

Immobilisation Cast

Question 18

When is an immobilisation cast used to manage scaphoid fractures?

Answer 18

Undisplaced fractures of the scaphoid waist

Question 19

How long are immobilisation casts used to manage scaphoid fractures?

Answer 19

6 - 8 weeks

Question 20

What is the surgical management option of scaphoid fractures?

Answer 20

Wrist Fixation

Question 21

When is wrist fixation used to manage scaphoid fractures?

Answer 21

It is used to manage displaced and proximal pole scaphoid fractures

Question 22

What are the four complications associated with scaphoid fractures?

Answer 22

Non-Union

Avascular Necrosis

Scapholunate Dissociation

Osteoarthritis

Question 23

What is the neovascular structure mainly compromised in scaphoid fractures?

Answer 23

The dorsal carpal branch of the radial artery

Question 24

What is the clinical feature of avascular necrosis?

Answer 24

Gradual worsening of pain in the affected wrist - sometimes years after the injury