SYB 3 Marni Scheiner
Jan 15, 2016
SYB 3 SYB 3
Marni ScheinerMarni Scheiner
Scaphoid FractureScaphoid Fracture
Most common type of wrist fracture Location: Radial aspect of the hand just
distal to the radius itself 65% at the waist 15% proximal pole 10% distal body Results mainly from a fall on an
outstretched arm proximal carpal row Fx > distal carpal row
Fx
http://ptclinic.com/medlibrary/images/v2/ScaphoidFracture.gif
Most common type of wrist fracture Location: Radial aspect of the hand just
distal to the radius itself 65% at the waist 15% proximal pole 10% distal body Results mainly from a fall on an
outstretched arm proximal carpal row Fx > distal carpal row
Fx
http://ptclinic.com/medlibrary/images/v2/ScaphoidFracture.gif
Scaphoid FractureScaphoid Fracture Mechanism of injury
fall on the outstretched arm with the wrist in dorsiflexion.
Symptoms/Exam Findings History of fall/trauma Pain localized to radial aspect of wrist (anatomic
snuffbox); increased with palpation Dorsoradial swelling ROM and grip strength reduced
Any tenderness in the snuffbox should be treated as a scaphoid fracture until proven otherwise
Mechanism of injury fall on the outstretched arm with the wrist in
dorsiflexion. Symptoms/Exam Findings
History of fall/trauma Pain localized to radial aspect of wrist (anatomic
snuffbox); increased with palpation Dorsoradial swelling ROM and grip strength reduced
Any tenderness in the snuffbox should be treated as a scaphoid fracture until proven otherwise
Scaphoid FractureScaphoid Fracture Radiographic Findings
Standard Radiographs PA, true lateral, and scaphoid view
Scaphoid View: PA with wrist in full pronation and ulnar deviation
Shows scaphoid in its most longitudinal axis; separates it on radiograph from shadows of the distal radius.
If questionable Fx alignment on plain radiographs, an MRI or CT scan should be obtained to correctly identify the amount of displacement
Radiographic Findings Standard Radiographs
PA, true lateral, and scaphoid view
Scaphoid View: PA with wrist in full pronation and ulnar deviation
Shows scaphoid in its most longitudinal axis; separates it on radiograph from shadows of the distal radius.
If questionable Fx alignment on plain radiographs, an MRI or CT scan should be obtained to correctly identify the amount of displacement
Scaphoid FractureScaphoid Fracture Should evaluate for signs of ligament
disruption (*esp scapholunate ligament).
"Terry Thomas” Sign Normal space b/w scaphoid and lunate
bones = 1-2mm Terry Thomas Sign
widened space (>3 mm) between the scaphoid and the lunate
accentuated in PA of closed hand in a fist with ulnar deviation
important since it is a cause of chronic wrist pain and disability if left untreated.
www.rcsed.ac.uk/.../hand/scapholunate_diss.htm
Should evaluate for signs of ligament disruption (*esp scapholunate ligament).
"Terry Thomas” Sign Normal space b/w scaphoid and lunate
bones = 1-2mm Terry Thomas Sign
widened space (>3 mm) between the scaphoid and the lunate
accentuated in PA of closed hand in a fist with ulnar deviation
important since it is a cause of chronic wrist pain and disability if left untreated.
www.rcsed.ac.uk/.../hand/scapholunate_diss.htm
Scaphoid FractureScaphoid Fracture Suspected fracture with negative plain
radiographs: If compressed or minimally displaced, initial
radiographs may be negative. Traditional approach:
immobilization followed by additional radiographs (7-10 days). CT/MRI
For definitive Dx in Pt can not tolerate any unnecessary immobilization (ex. a competitive athlete)
CT scan more readily available
MRI less costly More information about ligamentous or other possible injuries
Suspected fracture with negative plain radiographs: If compressed or minimally displaced, initial
radiographs may be negative. Traditional approach:
immobilization followed by additional radiographs (7-10 days). CT/MRI
For definitive Dx in Pt can not tolerate any unnecessary immobilization (ex. a competitive athlete)
CT scan more readily available
MRI less costly More information about ligamentous or other possible injuries
Scaphoid FractureScaphoid Fracture Complications
Malunion
Delayed Union
Nonunion
*AVASCULAR NECROSIS (AVN) Osteonecrosis is more common in scaphoid Fx’s than most
other bones; 15-30% of all scaphoid fractures most commonly involves the proximal pole blood supply runs from distal to proximal leading to the
possibility of non-union or osteonecrosis of the proximal pole
Complications Malunion
Delayed Union
Nonunion
*AVASCULAR NECROSIS (AVN) Osteonecrosis is more common in scaphoid Fx’s than most
other bones; 15-30% of all scaphoid fractures most commonly involves the proximal pole blood supply runs from distal to proximal leading to the
possibility of non-union or osteonecrosis of the proximal pole
Scaphoid FractureScaphoid Fracture Treatment
If Fx displaced (≥ 1 mm) and/or significantly increased or decreased scapholunate angle
immobilize in a thumb spica splint and referred for orthopedic evaluation.
Non-displaced fractures (<1 mm) short-arm thumb-spica cast typically for six to 10 weeks.
Fractures at the waist or proximal third could be given more substantial immobilization in a long-arm cast.
If immobilization is not an option, operative fixation is suggested.
Athletes: rigid protection for 2 months after radiographic healing.
Treatment If Fx displaced (≥ 1 mm) and/or significantly increased or
decreased scapholunate angle immobilize in a thumb spica splint and referred for orthopedic
evaluation.
Non-displaced fractures (<1 mm) short-arm thumb-spica cast typically for six to 10 weeks.
Fractures at the waist or proximal third could be given more substantial immobilization in a long-arm cast.
If immobilization is not an option, operative fixation is suggested.
Athletes: rigid protection for 2 months after radiographic healing.