T&O: Scaphoid fracture

Question 1

If a scaphoid fracture of a broken wrist was missed and led to avascular necrosis. What might the patient complain of?

Answer 1

Pain

Stiffness

Reduced function

Question 2

What is the mechanism of injury of a scaphoid fracture

Answer 2

FOOSH
The extended position of the wrist when falling = force of fall goes through scaphoid = fractures

Question 3

What are the symptoms of a scaphoid fracture?

Answer 3

Pain on palpation of the anatomical snuffbox
Pain while telescoping the thumb

Question 4

A patient presents to the ED with a suspected scaphoid fracture, on xray there is no abnormality, what would your next steps be?

Answer 4

Immobilisation of the wrist in a thumb spica cast (beer glass position) and arrange a repeat xray in 10-14 days

Question 5

What are differentials for scaphoid fracture?

Answer 5

• Distal radius fracture = get pain, swelling and limited motion in the wrist, may have deformity
• wrist sprain = get pain, swelling, bruising and decreased range of motion, but no deformity
• carpal bone fracture (that isn’t scaphoid) = pain, swelling, decreased ROM

Question 6

What are complications of saphoid fracture?

Answer 6

Avasc necrosis
* get ongoing pain and stiffness in the wrist