Suspected Scaphoid Fracture

Question 1

True/False
Scaphoid is the most commonly fractured carpal bone

Answer 1

True

Question 2

Scaphoid Fx
(1) Usually fractured from falls with _____
(2) Diagnosis is often delayed or missed and has a significant incidence of _______ and _____
(3) Major blood supply enters the bone in the distal third and be disrupted with injury
(4) Displacement greater than 1mm has a high rate of nonunion

Answer 2

1) outstretched hand
2) nonunion and osteonecrosis

Question 3

Clinical Symptoms
(1) Patient describes a dorsiflexed wrist injury
(2) Pain about the radial side of the wrist in the anatomical snuffbox
(3) Pain with wrist motion and gripping
c. Physical Exam
(1) Visual = Edema focal to the distal radial aspect of the wrist
(2) Palpation
–(a) Tenderness in the snuffbox region
–(b) Tenderness over scaphoid tubercle on the underside of wrist
(3) ROM = Typically normal
(4) Muscle Test = Decreased grip strength
(5) Neurovascular
–(a) Evaluate the median, ulnar and radial nerves for possible compromise
(6) Special Tests = None

Answer 3

Suspected Scaphoid Fracture
Treatment
(1) ** Thumb spica splint**
(2) Light duty- no use of affected hand
(3) Treatment strategy should focused on definitive diagnosis with radiographs or MRI as
soon as possible
(4) Consult to orthopedics
(5) Analgesics as needed

Question 4

Diagnostic Tests
(1) Scaphoid series radiographs should be obtained at ____
(2) If normal but pain persists for ____weeks then studies should be repeated
(3) If radiographs are still normal, an ____ should be ordered

Answer 4

1) time of injury
2) 2-3
3) MRI

Question 5

Referral Decisions / Red Flags
(1) Displaced fractures of scaphoid require early orthopedic evaluation for possible surgical evaluation
(2) Scaphoid fracture with wrist ligament injuries require urgent referral to ______

Answer 5

hand surgeon