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Scaphoid fracture

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scaphoid bone back together at the most perpendicular angle possible to promote quicker and stronger healing of the bone. Internal fixation can be done dorsally with a percutaneous incision and arthroscopic assistance or via a minimal open dorsal approach, or via a volar approach in which case slight excavation of the edge of the trapezium bone may be necessary to reach the scaphoid as 80% of this bone is covered with articular cartilage, which makes it difficult to gain access to the scaphoid.
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study, 439 patients were randomly allocated to either cast immobilisation or surgical fixation. There was no difference in the healing, pain and function or days off work between the two treatment groups, the cast immobilisation group had less complications and this treatment was more cost effective. The choice of short arm, short arm
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cast with the thumb left free. Non displaced or minimally displaced fracture can also be treated with percutaneous or minimal incision surgery which if performed correctly has a high union rate, low morbidity and faster return to activity than closed cast management. However this was not confirmed by the SWIFFT study.
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Fractures that are more proximal take longer to heal. It is expected the distal third will heal in 6 to 8 weeks, the middle third will take 8–12 weeks, and the proximal third will take 12–24 weeks. The Scaphoid receives its blood supply primarily from lateral and distal branches of the radial artery.
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For non and minimally displaced fractures (up to 2mm) of the scaphoid waist, cast immobilisation (with surgical fixation for non-united fractures at 6 to 12 weeks) is as effective as immediate surgery fixation. This was demonstrated by the SWIFFT (Scaphoid Waist Internal Fixation for Fractures Trial)
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and multiple views are obtained as standard. However, not all fractures are apparent initially. In 1/4 of cases, the clinical examination suggests a fracture, but the X-ray does not show it, even though there is indeed a fracture. Therefore, people with tenderness over the scaphoid (those who exhibit
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Percutaneous screw fixation is recommended over an open surgical approach when it is possible to achieve acceptable bone alignment closed as minimal incisions can preserves the palmar ligament complex and local vasculature, and help avoid soft tissue complications. This surgery includes screwing the
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or long arm cast is debated in the medical literature and no clear consensus or proof of the benefit of one type of casting or another has been shown; although it is generally accepted to use a short arm or short arm thumb spica for non displaced fractures. In the SWIFFT study most used a short arm
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In the aftermath, 90% of non-operated individuals return to sports, with 88% reaching their previous level. Among those who underwent surgery, the rate of returning to sports is 98%, and 96% return to their previous level. The average time observed for resuming sports is 14 weeks for non-operated
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can also occur from undiagnosed or undertreated scaphoid fractures. Arterial flow to the scaphoid enters via the distal pole and travels to the proximal pole. This blood supply is tenuous, increasing the risk of nonunion, particularly with fractures at the wrist and proximal end. If not treated
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Vascular supply of the scaphoid comes from two different vascular pedicles. 20-30% of the blood supply (a.) comes from the volar branch of the radial artery and enters the bone at the tubercle. 70-80% comes from (b.) the dorsal branch of the radial artery and travels towards the proximal pole.
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Symptoms may include aching in the wrist, decreased range of motion of the wrist, and pain during activities such as lifting or gripping. If x-ray results show arthritis due to an old break, the treatment plan will first focus on treating the arthritis through anti-inflammatory medications and
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Fractures of the scaphoid are common in young males. They are less common in children and older adults because the distal radius is weaker contributor to the wrist and more likely to fracture in these age groups. Scaphoid fractures account for 50%-80% of carpal injuries.
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Blood flows from the top/distal end of the bone in a retrograde fashion down to the proximal pole; if this blood flow is disrupted by a fracture, the bone may not heal. Surgery is necessary at this point to mechanically mend the bone together.
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wearing a splint when an individual feels pain in the wrist. If these treatments do not help the symptoms of arthritis, steroid injections to the wrist may help alleviate pain. Should these treatments not work, surgery may be required.
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Slade JF 3rd, Gutow AP, Geissler WB. Percutaneous internal fixation of scaphoid fractures via an arthroscopically assisted dorsal approach. J Bone Joint Surg Am. 2002;84-A Suppl 2:21-36. doi:10.2106/00004623-200200002-00003
325:(AVN) is one complication of scaphoid fracture. Since the scaphoid receives its arterial supply in a retrograde fashion (i.e. from distal to proximal pole), the part proximal to the fracture is usually affected. 1395: 1380: 459:
Treatment of scaphoid fractures is guided by the location in the bone of the fracture (proximal, waist, distal), displacement (or instability) of the fracture, and patient tolerance for cast immobilization.
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Focal tenderness is usually present in one of three places: 1) volar prominence at the distal wrist for distal pole fractures; 2) anatomic snuff box for waist or midbody fractures; 3) distal to
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for 7–10 days at which point a second set of X-rays is taken. If a minimally displaced fracture was present initially, healing will now be apparent. Even then a fracture may not be apparent. A
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system, there are three main types of scaphoid fractures. 10%-20% of fractures are at the proximal pole, 60%-80% are at the waist (middle), and the remainder occur at the distal pole.
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Fractures of scaphoid can occur either with direct axial compression or with hyperextension of the wrist, such as a fall on the palm on an outstretched hand. Using the
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can then be used to evaluate the scaphoid with greater resolution. The use of MRI, if available, is preferred over CT and can give one an immediate diagnosis.
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Scaphoid fractures are most commonly caused by a fall on an outstretched hand. Diagnosis is generally based on a combination of clinical examination and
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These are also called navicular fractures (the scaphoid also being called the carpal navicular), although this can be confused with the
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Tada K, Ikeda K, Okamoto S, Hachinota A, Yamamoto D, Tsuchiya H (2015). "Scaphoid Fracture--Overview and Conservative Treatment".
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is generally sufficient. If the fracture is displaced then surgery is generally recommended. Healing may take up to six months.
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Phillips TG, Reibach AM, Slomiany WP (September 2004). "Diagnosis and management of scaphoid fractures".
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Waist fractures in the middle third is the most frequent fracture site and has moderate risk of AVN.
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Scaphoid fractures occur in three locations: (A) Distal tubercle, (B) waist, and (C) proximal pole.
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Dias JJ, Brealey SD, Fairhurst C, Amirfeyz R, Bhowal B, Blewitt N, et al. (August 2020).
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Dias J, Brealey S, Cook L, Fairhurst C, Hinde S, Leighton P, et al. (October 2020).
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Radiolucency around a 12 days old scaphoid fracture that was initially barely visible.
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Jarraya M, Hayashi D, Roemer FW, Crema MD, Diaz L, Conlin J, et al. (2013).
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during certain activities. In those in whom the fracture remains well aligned a
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is also an effective method for diagnosis fracture which do not appear on Xray.
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Gutow AP (August 2007). "Percutaneous fixation of scaphoid fractures".
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is generally tender and swelling may occur. Complications may include
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Fractures in the proximal third have a high incidence of AVN (~30%)
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An X-ray showing a fracture through the waist of the scaphoid
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Fractures in the distal third are rarely complicated by AVN.
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The Journal of the American Academy of Orthopaedic Surgeons
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Fracture of the tubercle of the scaphoid bone of the wrist
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A more obvious scaphoid fracture on a scaphoid view X ray
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correctly non-union of the scaphoid fracture can lead to
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Scaphoid pseudarthrosis, before and after treatment with
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Risk of AVN depends on the location of the fracture.
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AAFP: Diagnosis and Management of Scaphoid Fractures
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Carpal scaphoid fracture, carpal navicular fracture
1492: 1157: 1155: 831: 709:Case Reports in Plastic Surgery & Hand Surgery 1286:Goffin JS, Liao Q, Robertson GA (February 2019). 2089: 950:Yin ZG, Zhang JB, Kan SL, Wang XG (March 2010). 1152: 949: 675: 673: 671: 280:People with scaphoid fractures generally have 264:. Males are affected more often than females. 1478: 1051: 1049: 390:Scaphoid fractures are often diagnosed using 234:. Some fractures may not be visible on plain 1251:The Journal of Hand Surgery, European Volume 897:The Journal of Hand Surgery, European Volume 1330: 760:. American Academy of Orthopedic Surgeons. 702: 668: 608: 606: 604: 602: 600: 598: 596: 594: 1485: 1471: 1046: 956:Clinical Orthopaedics and Related Research 592: 590: 588: 586: 584: 582: 580: 578: 576: 574: 38: 16:Fracture of the scaphoid bone in the wrist 1313: 1303: 1262: 1244: 1135: 1026: 1016: 975: 908: 890: 728: 249:The fracture may be preventable by using 832:Egol KA, Koval KJ, Zuckerman JD (2015). 543: 541: 539: 537: 535: 533: 531: 529: 527: 381: 361: 310: 298: 271: 793: 571: 73:Pain at the base of the thumb, swelling 2090: 1340:. Thieme New York. 2003. p. 188. 559:from the original on 24 September 2017 223:of the proximal part of the bone, and 1466: 1161: 1105: 1103: 764:from the original on December 7, 2015 751: 633: 524: 267: 1580:Zygomaticomaxillary complex fracture 1213: 827: 825: 823: 789: 787: 785: 783: 781: 779: 679: 13: 1973:Combined tibia and fibula fracture 1100: 796:Essentials of musculoskeletal care 489:) can occur in 2 to 5% of cases. 260:It is the most commonly fractured 14: 2114: 1358: 864: 820: 776: 395:pain to pressure in the anatomic 189:Healing may take up to six months 1245:Suh N, Grewal R (January 2018). 1176:10.5435/00124635-200708000-00004 939:from the original on 2010-06-16. 891:Suh N, Grewal R (January 2018). 754:"Scaphoid Fracture of the Wrist" 703:Tokyay A, Gunal I (2015-01-20). 692:from the original on 2013-10-29. 549:"Scaphoid Fracture of the Wrist" 442: 430: 418: 294: 1279: 1238: 1207: 1198: 1005:Radiology Research and Practice 992: 943: 925: 884: 496: 1648:Vertebral compression fracture 858: 745: 696: 505: 1: 1338:Beasley's Surgery of the Hand 1216:"Percutaneous Screw Fixation" 1077:10.1016/S0140-6736(20)30931-4 721:10.3109/23320885.2015.1006633 517: 291:for proximal pole fractures. 1292:World Journal of Orthopedics 1116:Health Technology Assessment 480: 454: 377: 357: 109:Fall on an outstretched hand 7: 1458:Wheeless: Scaphoid fracture 871:Radiology Reference Article 141:De Quervain's tenosynovitis 10: 2119: 2103:Injuries of wrist and hand 1623:Craniocervical instability 425:A subtle scaphoid fracture 401:) are often splinted in a 2042: 2019: 2000: 1971: 1958:Le Fort fracture of ankle 1942: 1891: 1884: 1861: 1818: 1742: 1713: 1704: 1681: 1658: 1628:Flexion teardrop fracture 1593: 1575:Le Fort fracture of skull 1545: 1504: 1415: 1366: 968:10.1007/s11999-009-1081-6 654:10.1142/S0218810415400018 615:American Family Physician 183: 164: 154: 145:scapholunate dissociation 130: 113: 105: 97: 77: 67: 51: 46: 37: 29: 24: 1264:10.1177/1753193417735973 910:10.1177/1753193417735973 101:Proximal, medial, distal 1804:Essex-Lopresti fracture 1734:Holstein–Lewis fracture 1618:Clay-shoveler fracture 1555:Basilar skull fracture 1305:10.5312/wjo.v10.i2.101 387: 372:Herbert classification 367: 317: 308: 277: 137:Distal radius fracture 132:Differential diagnosis 1982:Trimalleolar fracture 834:Handbook of fractures 385: 365: 314: 302: 275: 119:Examination, X-rays, 1987:Bimalleolar fracture 1953:Maisonneuve fracture 682:"Scaphoid fractures" 348:wrist osteoarthritis 276:Anatomical snuff box 1638:Holdsworth fracture 1565:Mandibular fracture 1532:Pathologic fracture 1522:Greenstick fracture 1517:Chalkstick fracture 1226:on December 8, 2015 1018:10.1155/2013/370169 794:Sarwark JF (2010). 1917:Toddler's fracture 1758:Monteggia fracture 1643:Jefferson fracture 1633:Hangman's fracture 1416:External resources 1071:(10248): 390–401. 388: 368: 322:Avascular necrosis 318: 309: 278: 268:Signs and symptoms 246:may be performed. 221:avascular necrosis 88:avascular necrosis 62:emergency medicine 2085: 2084: 2038: 2037: 1963:Bosworth fracture 1912:Gosselin fracture 1871:Duverney fracture 1814: 1813: 1683:Shoulder fracture 1603:Cervical fracture 1512:Avulsion fracture 1448: 1447: 873:. Radiopaedia.org 867:"Scaphoid series" 411:Bone scintigraphy 392:plain radiographs 289:Lister's tubercle 219:of the fracture, 213:anatomic snuffbox 197:scaphoid fracture 193: 192: 115:Diagnostic method 25:Scaphoid fracture 19:Medical condition 2110: 2021:Femoral fracture 2011:Patella fracture 1944:Fibular fracture 1934:Tillaux fracture 1927:Plafond fracture 1889: 1888: 1744:Forearm fracture 1715:Humerus fracture 1711: 1710: 1673:Sternal fracture 1560:Blowout fracture 1498:cartilage damage 1487: 1480: 1473: 1464: 1463: 1364: 1363: 1352: 1351: 1334: 1328: 1327: 1317: 1307: 1283: 1277: 1276: 1266: 1242: 1236: 1235: 1233: 1231: 1222:. 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March 2016. 522: 521: 519: 516: 512:navicular bone 507: 504: 498: 495: 487:pseudarthrosis 482: 479: 456: 453: 452: 451: 448: 441: 439: 436: 429: 427: 424: 417: 379: 376: 359: 356: 340: 339: 336: 333: 296: 293: 269: 266: 191: 190: 187: 181: 180: 166: 162: 161: 156: 152: 151: 134: 128: 127: 117: 111: 110: 107: 103: 102: 99: 95: 94: 81: 75: 74: 71: 65: 64: 55: 49: 48: 44: 43: 35: 34: 31: 27: 26: 18: 15: 9: 6: 4: 3: 2: 2115: 2104: 2101: 2099: 2096: 2095: 2093: 2078: 2075: 2073: 2070: 2068: 2065: 2063: 2060: 2058: 2055: 2053: 2050: 2049: 2047: 2045: 2044:Foot fracture 2041: 2031: 2028: 2027: 2025: 2022: 2018: 2012: 2009: 2008: 2006: 2003: 2002:Crus fracture 1999: 1993: 1990: 1988: 1985: 1983: 1980: 1979: 1977: 1974: 1970: 1964: 1961: 1959: 1956: 1954: 1951: 1950: 1948: 1945: 1941: 1935: 1932: 1928: 1925: 1924: 1923: 1920: 1918: 1915: 1913: 1910: 1908: 1905: 1903: 1900: 1899: 1897: 1894: 1890: 1887: 1883: 1877: 1874: 1872: 1869: 1868: 1866: 1864: 1860: 1854: 1853:Broken finger 1851: 1849: 1846: 1844: 1841: 1839: 1836: 1834: 1831: 1829: 1826: 1825: 1823: 1821: 1820:Hand fracture 1817: 1805: 1802: 1800: 1797: 1795: 1792: 1790: 1787: 1785: 1782: 1780: 1777: 1776: 1775: 1774:Distal radius 1771: 1768: 1764: 1763:Hume fracture 1761: 1759: 1756: 1755: 1754: 1753:Ulna fracture 1751: 1750: 1748: 1745: 1741: 1735: 1732: 1730: 1729:Supracondylar 1727: 1725: 1722: 1721: 1719: 1716: 1712: 1709: 1707: 1703: 1697: 1694: 1692: 1689: 1688: 1686: 1684: 1680: 1674: 1671: 1669: 1666: 1665: 1663: 1661: 1657: 1649: 1646: 1644: 1641: 1639: 1636: 1634: 1631: 1629: 1626: 1624: 1621: 1619: 1616: 1614: 1611: 1609: 1606: 1605: 1604: 1601: 1600: 1598: 1596: 1592: 1586: 1583: 1581: 1578: 1576: 1573: 1571: 1568: 1566: 1563: 1561: 1558: 1556: 1553: 1552: 1550: 1548: 1544: 1538: 1535: 1533: 1530: 1528: 1527:Open fracture 1525: 1523: 1520: 1518: 1515: 1513: 1510: 1509: 1507: 1503: 1499: 1495: 1488: 1483: 1481: 1476: 1474: 1469: 1468: 1465: 1459: 1456: 1454: 1451: 1450: 1440: 1437: 1434: 1431: 1427: 1426: 1422: 1421: 1418: 1414: 1406: 1402: 1401: 1397: 1393: 1391: 1387: 1386: 1382: 1378: 1377: 1374: 1369: 1365: 1349: 1347:9781282950023 1343: 1339: 1333: 1325: 1321: 1316: 1311: 1306: 1301: 1297: 1293: 1289: 1282: 1274: 1270: 1265: 1260: 1256: 1252: 1248: 1241: 1225: 1221: 1220:AO Foundation 1217: 1210: 1201: 1193: 1189: 1185: 1181: 1177: 1173: 1169: 1165: 1158: 1156: 1147: 1143: 1138: 1133: 1129: 1125: 1122:(52): 1–234. 1121: 1117: 1113: 1106: 1104: 1094: 1090: 1086: 1082: 1078: 1074: 1070: 1066: 1059: 1052: 1050: 1043: 1038: 1034: 1029: 1024: 1019: 1014: 1010: 1006: 1002: 995: 987: 983: 978: 973: 969: 965: 961: 957: 953: 946: 938: 934: 928: 920: 916: 911: 906: 902: 898: 894: 887: 872: 868: 861: 853: 849: 845: 839: 835: 828: 826: 824: 815: 811: 807: 801: 797: 790: 788: 786: 784: 782: 780: 763: 759: 755: 748: 740: 736: 731: 726: 722: 718: 714: 710: 706: 699: 691: 687: 683: 676: 674: 672: 663: 659: 655: 651: 647: 643: 636: 628: 624: 620: 616: 609: 607: 605: 603: 601: 599: 597: 595: 593: 591: 589: 587: 585: 583: 581: 579: 577: 575: 558: 554: 550: 544: 542: 540: 538: 536: 534: 532: 530: 528: 523: 515: 514:in the foot. 513: 503: 494: 490: 488: 485:A non-union ( 478: 474: 470: 467: 461: 445: 440: 433: 428: 421: 416: 415: 414: 412: 408: 404: 400: 399: 393: 384: 375: 373: 364: 355: 351: 349: 344: 337: 334: 331: 330: 329: 326: 324: 323: 313: 306: 305:Herbert screw 301: 295:Complications 292: 290: 285: 283: 274: 265: 263: 258: 256: 252: 247: 245: 241: 237: 233: 228: 226: 222: 218: 214: 210: 206: 205:scaphoid bone 202: 198: 188: 186: 182: 178: 174: 170: 169:Not displaced 167: 163: 160: 157: 153: 150: 146: 142: 138: 135: 133: 129: 126: 122: 118: 116: 112: 108: 104: 100: 96: 93: 89: 85: 82: 80: 79:Complications 76: 72: 70: 66: 63: 59: 56: 54: 50: 45: 41: 36: 32: 28: 23: 2030:Hip fracture 1827: 1706:Arm fracture 1668:Rib fracture 1423: 1394: 1379: 1337: 1332: 1295: 1291: 1281: 1254: 1250: 1240: 1230:November 30, 1228:. 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Index


Specialty
Hand surgery
emergency medicine
Symptoms
Complications
Nonunion
avascular necrosis
arthritis
Diagnostic method
MRI
bone scan
Differential diagnosis
Distal radius fracture
De Quervain's tenosynovitis
scapholunate dissociation
sprain
Wrist guards
Cast
Prognosis
break
scaphoid bone
wrist
anatomic snuffbox
nonunion
avascular necrosis
arthritis
medical imaging
X-rays
MRI

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