Scaphoid Fractures

Question 1

What are the complications of scaphoid fractures

Answer 1

AVN
Non-union
Mal-union

SNAC wrist (Scaphoid Non-union advance collapse)

SLAC wrist (Scapholunate advanced collapse)

Question 2

What are the scaphoid views?

Answer 2

Scaphoid view – Postero-Anterior (PA) centered over scaphoid

Lateral

Oblique

PA Ulna deviation view

PA clenched fist

Question 3

What is the blood supply of the scaphoid?

Answer 3

The dorsal carpal branch supplies 80% of the scaphoid originating from the radial artery. It enters the scaphoid on the dorsal surface and supplies proximally via a retrograde blood flow. The retrograde nature of this artery results in more proximal fractures having a higher rate of nonunion

Question 4

What are classifications for the scaphoid fracture

Answer 4

Mayo classification system:

Type I
Distal tubercle fracture
Type II
Distal articular surface fracture
Type III
Distal third fracture
Type IV
Middle third fracture
Type V
Proximal third fracture

Question 5

Describe the managment of scaphoid fractures

Answer 5

Below elbow cast - don’t need to include the thumb (just usual cast)

Reserved for fractures:

With low risk of AVN

Wait fractures <2mm displacement (union rates 90%) - as per SWIFT trial

Distal pole fractures

The healing time is months rather than weeks

• ORIF (headless compression screw / plating)

Proximal pole fractures

Waist Displacement >2mm

Severe scaphoid humpback deformity

Scaphoid fractures associated with perilunate dislocation

Unstable vertical or oblique fractures

Question 6

Describe the SWIFT Trail?

Answer 6

RCT
Bicortical scaphoid waist fracture
< 2mm displacement
No difference in PROM.

Question 7

What features of a scaphoid fracture put them at increased risk of avascular necrosis?

Answer 7

Proximal pole fracture due to reterograde blood supply.
Multifragmentary
Displaced scaphoid fractures.