Scaphoid Fractures
Description
The scaphoid is the most frequently fractured carpal bone of the wrist. The most common cause of a scaphoid fracture is from a fall onto an outstretched hand where the wrist is in hyperextension. It is important to consider the possibility of a scaphoid fracture in any patient presenting with a sprained wrist. A scaphoid fracture can lead to serious complications including problems with delayed or non-union due to poor blood supply in the proximal pole of the scaphoid.
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Signs & Symptoms
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Diagnostic Tests
-Pain, point tenderness, and swelling in anatomical snuffbox
2. Observe swelling in the anatomical snuffbox 3. Scaphoid Compression Test: pain with examiner applied axial compression of the thumb into the anatomical snuffbox 4. Pain at the snuffbox with resisted pronation of the wrist -X-rays should be requested if there are 2 or more of the 4 clinical signs for a scaphoid fracture
an oblique view -An X-ray can confirm a scaphoid fracture but cannot exclude it -Treatment is different for a clinical scaphoid fracture and a radiologic confirmed fracture -The management strategy is to teat a suspected scaphoid fracture by casting the wrist right away even in the absence of positive radiological findings PT Implications
-Repeat X-rays 10-14 days later
-Reviewed by an orthopaedic specialist
-High risk of avascular necrosis or non-union: -Can lead to serious hand disability, arthritis, and pain -Avascular necrosis suspected with radial wrist or anatomical snuffbox pain, crepitus, and decrease power and range of motion. -Can still occur 2 years post injury |