scaphoid fractures

Question 1

Name the bones of the hand

Answer 1

Straight Line to Pinky

Here comes the thumb

Scaphoid
Lunate
triquetum
pisiform

Hamate
capitate
trapeziod
trapezium

Question 2

where does the blood supply to the capitate come from?

Answer 2

branches of the radial artery

dorsal branch of the radial artery, which supplies 80% of the blood, enters in the distal pole and travels in a retrograde fashion towards the proximal pole of the scaphoid.

Question 3

how can a scaphoid fracture compromise blood supply?

Answer 3

fractures can compromise the blood supply. leading to avascular necrosis and subsequent degenerative wrist disease

the more proximal the scaphoid fracture, the higher the risk of AVN

Question 4

why is a proximal scaphoid fracture more dangerous?

Answer 4

The dorsal branch of the radial artery, which supplies 80% of the blood, enters in the distal pole and travels in a retrograde fashion towards the proximal pole.

Question 5

what are the clinical features of scaphoid fractures?

Answer 5

• history of high energy trauma
• sudden onset wrist pain
• bruising
• tenderness in the floor of anatomical snuffbox
• pain on palpating the scaphoid tubercle
• pain on telescoping of thumb

Question 6

what investigations are done?

Answer 6

plain radiographs
get anteroposterior, lateral and oblique views

if not detected but still clinical suspicion, immobilise with thumb splint and repeat radiographs in 10-14 days

still no evidence, can do an MRI wrist

Question 7

how is a scaphoid fracture managed?

Answer 7

undisplaced - immobilisation in plaster and thumb splint

undisplaced fracture of proximal pole has a high risk of AVN and may need surgery

displaced fractures should be fixed surgically

Question 8

what are the complications of scaphoid fractures?

Answer 8

• AVN

- non union (may need internal fixation and bone grafts)