scaphoid anatomy and fractures

1. Yahyia alabri
Junior
Scaphoid fractures
By Yahyia Al-Abri

2.  Almost 75% of all carpal fractures.
 Mechanism is a fall on the hand with wrist
extended.
 The critical movement is probably a
combination of dorsiflexion and radial
deviation

3. Clinical features
 Tenderness upon palpation at the snuffbox and
volar tubercle.
 Range of motion (ROM) is reduced, but not
dramatically.
 Swelling around the radial and posterior aspects
of the wrist is common

4. Special test
 Watson test

5. Imaging
 X-rays most sensitive radiographic evaluation
includes 4 views: PA, lateral, pronated oblique
(60° pronated oblique), and ulnar deviated
oblique (also described as 60° supinated
oblique).
 The fracture may not be seen in the first few days
after the injury.
 Two weeks later, the break is usually much
clearer,
 Due to bone resorption at the fracture site and slight
displacement of fragments

7.  CT scan is more sensitive for diagnosing a
scaphoid fracture.
 MRI is the definitive way to confirm or exclude a
diagnosis of scaphoid fracture if the technique is
available.

8. Treatment
 If the x-ray looks normal but the clinical features are
suggestive of a fracture, the patient must not be
discharged.
 second x-ray 2 weeks later.
 Meanwhile, the wrist is immobilized in a cast

9. Treatment
 Fracture of the scaphoid tubercle
 a crepe bandage is applied and movement is
encouraged.
 Undisplaced fractures of the waist
 can be treated in plaster for 8 weeks; 90% should
heal.
 If the scaphoid is tender, or the fracture still
visible on x-ray, when non-operative treatment is
chosen, the cast is re-applied and retained for a
further 6 weeks.

10.  Displaced fractures
 Reduce the fracture and to fix it with a
compression screw.
 Proximal pole fractures
 a poor rate of healing
 a long time in plaster (and even then sometimes not
heald)
 a percutaneous screw.

11. COMPLICATION
 NON-UNNION
 AVASCULAR NECROSIS
 OSTEOARTHRITIS