Scaphoid Fractures

Question 1

What is the most common mechanism for a scaphoid fracture?

Answer 1

axial load across hyper-extended and radially deviated wrist; most commonly fractured at the waist of scaphoid

Question 2

Why do scaphoid fractures have a higher incidence of AVN?

Answer 2

Majority of blood supply enters distally and perfuses via retrograde flow
Proximal 3rd fx AVN rate of 33%
Proximal 5th fx AVN rate of 100%

Question 3

What is the most specific imaging modality for occult scaphoid fractures?

Answer 3

MRI

Bone scan and thin slice CT can also help

Question 4

What is the advantage of ORIF of a non-displaced scaphoid fracture when compared to conservative management?

Answer 4

1) decreased time to union
2) faster return to work/sport
3) similar total costs compared to casting

Question 5

An open dorsal approach for antegrade screw fixation of a nondisplaced scaphoid waist fracture has what advantage compared to a percutaneous dorsal approach?

Answer 5

decreased risk of leaving screw above subchondral bone