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Scaphoid fracture
1. S C A P H O I D F R A C T U R E
G O P I S A N K A R . M . G
Case discussion
2. Scaphoid
A commonly fractured bone
Most common congenitally absent bone
Visible and palpable part is tuberosity of scaphoid in
anterior aspect of wrist
It is more visible dorsiflexion and radial deviation of
wrist why because scaphoid undergoes flexion at this
position
4. The above reasons explain why falling on out
strectched hand produces this fracture
As when we fall--- keeps the wrist in dorsiflexion
and radial deviation
Actually it also depends on (that is fracture) angle
between the forearm and wrist
When that angle is around 90 degree we fall on the
tuberosity directly
5. If angle is at 60 degree u get????
Distal fracture colles fracture
If angle less than that ie less than 60 degree u may
get forearm bones fracture radius or ulna
Thus mechanism of injury is very important
6. Scaphoid means “boat shaped”
70 percent of the bone is covered by articular
cartilage
Rest by bone
7. Blood supply is via radial artery
Two grops volar and dorsal
Volar supplies the scaphoid tubercle
Dorsal supply is from distal to proximal so
proximal pole is not getting direct blood supply
So in fracture it can undergo AVN (avascular
necrosis)
8. Parts of scaphoid
Proximal pole(AVN chance)
Waist (most common site of fracture)
Distal pole
Tuberosity
10. Signs
1. Tenderness in the anatonical snuff box
As floor of the snuff box is formed by the scaphoid
and trapezius bone
11. 2. Axial compression on the thumb produces pain
3. Pronate against resistance causes pain
12. Xray AP,Lat ,Oblique
View in ulnar deviation an undisplaced fracture can
be found
but Xrays may be negative for first two weeks
Other options isotope bone scan Tc 99
MRI
3D CT scan
13. Management
Undisplaced plaster
Scaphoid cast glass holding position extends upto
distal transverse crease in other fingers
On thumb upto base of P2
Casts for a minimum of 6 weeks
Take xray
14. If displaced
Better to cannulate the bone unde C arm guidance
Or can do open reduction
Implant is Herbert’s screw it is a cannulated screw
and a handleless screw
With differential pitch that is thread size on one end
is not similar to another
15. We put it from distal to proximal
Distal is bigger thatn proxiamal
After Herebert’s screw 3 months immobilisation
16. When will u call as nonunion
After 4 months if not united
More with conservatuve management
In displaced fracture
17. xray
Proximal fragment sclerosis
Can excise it if it is less than 20% of total area of
scaphoid
If big can do bone grafting
Vascularised graft
18. Graft options
1. Take a free vascularised bone graft ---take a bone
graft with blood supply and anastomosis
2. Take a piece of bone with muscle and intact BS
---pronator quadratus and radius and put into
scaphoid
19. If neglected
SNAC Scaphoid Nonunion Asdvanced Collpase
Secondary osteoarthritis
Finally may have to wristy arthrodesis at 30 degree
flexion