Scaphoid Fracture
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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
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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]
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.
