Scaphoid Fracture: Difference between revisions
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== Clinically Relevant Anatomy<br> == | == Clinically Relevant Anatomy<br> == | ||
The scaphoid is one of the 8 carpal bones of the wrist. It’s an important boat-shaped carpal bone that articulates with the distal radius, trapezium, and capitate. During dorsiflexion and radial deviation of the wrist, the motion is limited by the scaphoid conflict on the radius. Stress on the scaphoid, due to a forceful motion, may have a fracture as result. Scapohid fractures make up 50-80% of all carpal fractures<ref name="3">T. Grant Phillips et al, Diagnosis and Management of Scaphoid Fractures, Am Fam Physician. 2004 Sep 1;70(5):879-884. Level of evidence: 5</ref>.<br>The major blood supply comes from the radial artery (seventy to eighty percent), twenty to thirty percent of the bone receives its blood supply from volar radial artery branches, feeding the dorsal surface. The proximal portion has no direct blood supply, what is an explanation for the cause of scaphoid necrosis on the basis of the vascular anatomy and an important complication of scaphoid fractures. <ref name="3">T. Grant Phillips et al, Diagnosis and Management of Scaphoid Fractures, Am Fam Physician. 2004 Sep 1;70(5):879-884. Level of evidence: 5</ref><ref>Gelberman RH, Menon J., The vascularity of the scaphoid bone, The Journal of Hand Surgery Am. 1980 Sep;5(5):508-13. Level of evicence:5</ref><br><br> | |||
== Mechanism of Injury / Pathological Process<br> == | == Mechanism of Injury / Pathological Process<br> == | ||
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Clinically Relevant Anatomy
[edit | edit source]
The scaphoid is one of the 8 carpal bones of the wrist. It’s an important boat-shaped carpal bone that articulates with the distal radius, trapezium, and capitate. During dorsiflexion and radial deviation of the wrist, the motion is limited by the scaphoid conflict on the radius. Stress on the scaphoid, due to a forceful motion, may have a fracture as result. Scapohid fractures make up 50-80% of all carpal fracturesCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
The major blood supply comes from the radial artery (seventy to eighty percent), twenty to thirty percent of the bone receives its blood supply from volar radial artery branches, feeding the dorsal surface. The proximal portion has no direct blood supply, what is an explanation for the cause of scaphoid necrosis on the basis of the vascular anatomy and an important complication of scaphoid fractures. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title[1]
Mechanism of Injury / Pathological Process
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Mechanism of injury is usually a fall onto an outstretched arm with wrist hyperextended and radial deviation. This position causes axial loading through the scaphoid. Less common mechanisms of injury are:
- wrist extension with deceleration such as with the hand on a steering wheel
- 'kickback' injuries from machinery
- hyperflexion injuries
- direct impact to the scaphoid
Most injuries are seen in men aged 15-30. 75-80% of fractures occur through the waist of the bone. 15-20% occur at the proximal pole. 10-15% of fractures occur at the distal pole.[2]
Clinical Presentation[edit | edit source]
Clinical presentation includes swelling and pain over the anatomical snuff box. The anatomical snuff box is the area between the extensor pollicis longus and the extensor pollicis brevis. Patient will usually also complain of pain with pressure over the scapoid tubercle. [2]
Diagnostic Procedure
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AP and lateral radiographs along with additional scaphoid views (pronated oblique and ulnar-deviated oblique) are used in diagnosing a scaphoid fracture. Up to 15% of scaphoid fractures are not evident on initial radiograph, however. [2] If fracture is suspected,MRI is the next line of imaging to confirm the diagnosis. [3]
Outcome Measures[edit | edit source]
DASH (see Outcome Measures Database)
Management / Interventions
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Cast immobilization is the standard treatment for treating a scaphoid fracture. With cast immobilization, chance of non-union is approximately 20%. Therefore, with displaced or unstable fractures, operative treatment is recommended. [4] Though this improves the rate of non-union, the complication rate for ORIF is 30%.[5]
Fractures are usually classified by Herbert and Fisher's system:
A: Acute but stable fractures such as fractures of the tubercle, incomplete or undisplaced fractures of the waist
B: Acute unstable fractures such as distal oblique fractures, complete waist fractures, proximal pole fractures, and
fracture dislocation
C: Fractures with evidence of delayed union
D: Fractures with established non-union[2]
Differential Diagnosis
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Differential diagnosis includes Colles' fracture,Salter-Harris fracture, other carpal fractures, scapholunate complex injury.[2]
Key Evidence[edit | edit source]
A systemic review suggests that percutaneous fixation may result in faster union and return to work or sport. There was no difference noted between cast fixation and ORIF. The authors suggest that cast treatment is a good treatment option for most. Surgery should be reserved for high level athletes and manual workers who cannot work in a cast.[5]
Resources
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Physical Therapy Management[edit | edit source]
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ Gelberman RH, Menon J., The vascularity of the scaphoid bone, The Journal of Hand Surgery Am. 1980 Sep;5(5):508-13. Level of evicence:5
- ↑ 2.0 2.1 2.2 2.3 2.4 Cite error: Invalid
<ref>tag; no text was provided for refs namedbethel - ↑ Henriksen et al. Two-Dimensional Image Fusion of Planar Bone Scintigraphy and Radiographs in Patients with Clinical Scaphoid Fracture: An Imaging Study. Acta Radiologica. February, 2009. 50(1): 71-77.
- ↑ Pfeiffer et al. A prospective multi-center cohort study of acute non-displaced fractures of the scaphoid: operative versus non-operative treatment. BMC Musculoskeletal Disorders. May, 2006. 7:41.
- ↑ 5.0 5.1 Modi et al. Operative versus nonoperative treatment of acute undisplaced and minimally displaced scaphoid waist fractures-A systemic review. Injury, Int. J. Care Injured. 2009. 40: 268-273.
