Scaphoid Fracture: Difference between revisions
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The main cause of injury is a fall on the outstretched hand with an radially deviated wrist, which results in extreme dorsiflexion at the wrist and compression to the radial side of the hand. There will be a massive force of the hand on the arm through the scaphoid bone<ref name="1" /><ref name="3" /><ref name="4" />. The patient experience a deep, dull ache in the radial part of the wrist. The pain, which often is mild, is aggravated by pinching and gripping. The wrist can be lightly swollen or bruised and, possibly, fullness in the anatomic snuffbox, suggesting a wrist effusion. Scaphoid fractures are most common in males 15 to 30 years of age<ref name="4" /> and are rare in young children and infants.<ref name="1" /> | The main cause of injury is a fall on the outstretched hand with an radially deviated wrist, which results in extreme dorsiflexion at the wrist and compression to the radial side of the hand. There will be a massive force of the hand on the arm through the scaphoid bone<ref name="1" /><ref name="3" /><ref name="4" />. The patient experience a deep, dull ache in the radial part of the wrist. The pain, which often is mild, is aggravated by pinching and gripping. The wrist can be lightly swollen or bruised and, possibly, fullness in the anatomic snuffbox, suggesting a wrist effusion. Scaphoid fractures are most common in males 15 to 30 years of age<ref name="4" /> and are rare in young children and infants.<ref name="1" /> | ||
== | == Differential Diagnosis == | ||
These diagnoses can be differentiated by the location of tenderness, pain with certain maneuvers, and radiographic abnormalities.<ref name="3" /><ref name="8">Bill Schloss Gillian Lieberman, MD, Scaphoid fractures, Harvard Medical School, Year Harvard Medical School, Year-IV. Januari 2001: pg 3. Level of evicence: 5</ref> | |||
{| width="400" border="1" cellpadding="1" cellspacing="1" | |||
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! scope="col" | Diagnosis | |||
! scope="col" | Physical And Radiographic Findings | |||
|- | |||
| Arthritis of the carpometacarpal or radiocarpal joint | |||
| Local tenderness, abnormal radiographs | |||
|- | |||
| De Quervain’s tenosynovitis | |||
| Lateral wrist pain, tenderness over radial styloid, positive Finkelstein’s test<br> | |||
|- | |||
| Distal radius fracture | |||
| Local tenderness and deformity, abnormal plain radiographs | |||
|- | |||
| Extensor carpi radialis strain<br>(longus and brevis) | |||
| Local tenderness, swelling, and pain elicited with wrist flexion | |||
|- | |||
| First metacarpal fracture | |||
| Local tenderness and deformity, abnormal plain radiographs | |||
|- | |||
| Flexor carpi radialis strain | |||
| Local tenderness, swelling, and pain elicited with wrist extension | |||
|- | |||
| Injuries to radioulnar joint | |||
| Local tenderness | |||
|- | |||
| Scapholunate dissociation | |||
| Tenderness over scapholunate ligament, increased gap between scaphoid and lunate on plain films | |||
|- | |||
| Scaphoid fracture | |||
| Anatomic snuffbox tenderness, pain with scaphoid compression test, tenderness of scaphoid tubercle | |||
|} | |||
== Clinical Presentation == | == Clinical Presentation == | ||
Revision as of 19:39, 22 May 2016
Original Editor - Dawn Waugh
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Search Strategy[edit | edit source]
Scaphoid fracture - Scaphoid- Scaphoid fracture therapy- Differential diagnosis Scaphoid fracture - Medical management scaphoid fracture- outcome measures scaphoid fracture- wrist disabilities- carpal navicular. We searched the most of the information at pubmed and ncib. A few things we found on PEDro ( physiotherapy evidence database).
Definition/ Description[edit | edit source]
The scaphoid bone is the most commonly fractured carpal bone. In young children and the elderly population scaphoid fractures are rare. The scaphoid bone is stronger than the relative weak distal radius compared in these age groups.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title A delay in diagnosis of scaphoid fractures can lead to a variety of adverse outcomes that include nonunion (no consolidation) , delayed union, decreased grip strength and range of motion, and osteoarthritis of the radiocarpal joint. Timely diagnosis, appropriate immobilization, and referral when indicated can decrease the likelihood of adverse outcomes.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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]
Epidemiology/ Etiology[edit | edit source]
Scaphoid fracture occur in people of all ages (10 – 70 years), although it is most common in young adult men following a fall, athletic injury, or motor vehicle accidentCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.Young male and persons between 10 and 19 years of age are at highest riskCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. Scaphoid fracture is uncommon in children because a fall results in a Salter type I or II fracture of the distal radius. Similarly, in elderly patients, the distal radial metaphysis usually fails before the scaphoid can fractureCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Scaphoid injuries are more common in men than in women.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The scaphoid has especially joint compressive forces which result in trapezial-scaphoid shear stress, and exerts control on the scaphoid by capitolunate rotation moments. Therefore, scaphoid fractures have a high incidence of nonunion (8-10%), frequent malunion, and late sequelae of carpal instability and posttraumatic arthritisCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
• Because no blood vessels enter the proximal pole of the scaphoid, a higher incidence of aseptic necrosis and nonunion is noted with fractures on this side of the scaphoid Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
• A scaphoid fracture can be presented in two ways: as a nondisplaced, stable fracture or as a displaced, unstable fracture.
The displaced fractures frequently are associated with ligamentous tears in the wrist. So evaluation and follow-up is recommendedCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Research shows that 2,4% of all wrist fractures are scaphoid fractures and there is an estimated incidence of scaphoid fractures of 29 per 100.000 personsCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Characteristics/ Clinical Presentation[edit | edit source]
The main cause of injury is a fall on the outstretched hand with an radially deviated wrist, which results in extreme dorsiflexion at the wrist and compression to the radial side of the hand. There will be a massive force of the hand on the arm through the scaphoid boneCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. The patient experience a deep, dull ache in the radial part of the wrist. The pain, which often is mild, is aggravated by pinching and gripping. The wrist can be lightly swollen or bruised and, possibly, fullness in the anatomic snuffbox, suggesting a wrist effusion. Scaphoid fractures are most common in males 15 to 30 years of ageCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title and are rare in young children and infants.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Differential Diagnosis[edit | edit source]
These diagnoses can be differentiated by the location of tenderness, pain with certain maneuvers, and radiographic abnormalities.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
| Diagnosis | Physical And Radiographic Findings |
|---|---|
| Arthritis of the carpometacarpal or radiocarpal joint | Local tenderness, abnormal radiographs |
| De Quervain’s tenosynovitis | Lateral wrist pain, tenderness over radial styloid, positive Finkelstein’s test |
| Distal radius fracture | Local tenderness and deformity, abnormal plain radiographs |
| Extensor carpi radialis strain (longus and brevis) |
Local tenderness, swelling, and pain elicited with wrist flexion |
| First metacarpal fracture | Local tenderness and deformity, abnormal plain radiographs |
| Flexor carpi radialis strain | Local tenderness, swelling, and pain elicited with wrist extension |
| Injuries to radioulnar joint | Local tenderness |
| Scapholunate dissociation | Tenderness over scapholunate ligament, increased gap between scaphoid and lunate on plain films |
| Scaphoid fracture | Anatomic snuffbox tenderness, pain with scaphoid compression test, tenderness of scaphoid tubercle |
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
[edit | edit source]
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
[edit | edit source]
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
[edit | edit source]
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 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.
