Upper limb fractures

Question 1

How do scaphoid fractures typically occur?

Answer 1

FOOSH (fall onto outstretched hand)
Contact sports

Question 2

What is the presentation of a scaphoid fracture?

Answer 2

Pain along the radial aspect of the wrist, at the base of the thumb
Loss of grip/pinch strength

Question 3

What are the signs of scaphoid fracture on examination?

Answer 3

Tenderness over the anatomical snuffbox
Wrist joint effusion
Pain elicited by telescoping of the thumb
Pain on ulnar deviation of the wrist

Question 4

What initial investigations are used to diagnose scaphoid fracture?

Answer 4

Plain film radiographs of the wrist in anterior-posterior view and lateral view

Question 5

What further investigations may be used to diagnose scaphoid fracture?

Answer 5

CT scan can give a more detailed view of the wrist bones if XR is inconclusive

Question 6

What is the initial management of a scaphoid fracture?

Answer 6

Immobilisation with futuro splint or standard below-elbow backslab
Referral to orthopaedics

Question 7

What is the orthopaedic management of a scaphoid fracture?

Answer 7

Undisplaced fracture
- Cast for 6-8 weeks

Displaced scaphoid fracture
- Surgical fixation

Proximal scaphoid pole fracture
- Requires surgical fixation

Question 8

What are the complications of scaphoid fracture?

Answer 8

Non-union - can lead to pain and early osteoarthritis
Avascular necrosis

Question 9

What is the blood supply to the scaphoid bone?

Answer 9

Retrograde blood supply - blood vessels supply the bone from only one direction