scaphoid fractures

Question 1

what is a scaphoid fracture?

Answer 1

a type of wrist fracture
typically arises as a FOOSH
results in axial compression of scaphoid, with the wrist hyperextended and radially deviated

Question 2

why is recognising scaphoid fractures important?

Answer 2

unusual blood supply of the scaphoid bone

80% of blood supply derived from dorsal carpal branch (branch of radial artery) in a retrograde manner

interruption of the blood supply risks AVN of the scaphoid

Question 3

what are the causes of a scaphoid fracture?

Answer 3

• FOOSH

- contact sports

Question 4

how do pts with a scaphoid fracture typically present with?

Answer 4

• pain along the radial aspect of the wrist, at the base of the thumb
• loss of grip / pinch strength

Question 5

what are the signs of a scaphoid fracture?

Answer 5

1. point of maximal tenderness over the anatomical snuffbox
2. wrist jt effusion
3. pain elicited by telescoping of the thumb
4. tenderness of scaphoid tubercle (on the volar aspect of the wrist)
5. pain on ulnar deviation of the wrist

Question 6

what are the ix for a scaphoid fracture?

Answer 6

• plain film radiographs of the wrist (AP and lateral view)

- MRI 2nd line if radiographs inconclusive

Question 7

what is the inital mx of a suspected/confirmed scaphoid fracture?

Answer 7

1. immobilisation with a Futuro splint or standard below-elbow backslab
2. referral to orthopaedics

Question 8

what is the orthopaedic mx of a scaphoid fracture?

Answer 8

undisplaced fractures of the scaphoid waist

• cast for 6-8 weeks
• union achieved in >95%

displaced scaphoid waist fractures
- surgical fixation

proximal scaphoid pole fractures
- surgical fixation

Question 9

what are the complications of a scaphoid fracture?

Answer 9

• non-union → pain and early OA

- AVN