Scaphoid fracture

    • Scaphoid fracture
      • it is more common in young adults but rare in children and in elderly people. (MCQ)
      • Commonly, the fracture occurs through the waist of the scaphoid(MCQ)
      • Clinical vignette:
        • Pain and swelling over the radial aspect of the wrist following a fall on an out-stretched hand, in an adult, should make one suspect strongly the possibility of a scaphoid fracture.(MCQ)
        • On examination, one may be able to elicit tenderness in the scaphoid fossa* (anatomical snuff box). (MCQ)
        • A force transmitted along the axis of second metacarpal may produce pain in the region of the scaphoid bone.(MCQ)
      • Radiological features:
        • X ray views to see scaphoid fracture
          • oblique view of the wrist(MCQ)
          • antero-posterior view
          • lateral view
        • What is next step in management in a clinically suspected case of scaphoid fracture if the fracture is not seen on X Ray ? (A high yield MCQ in PG Medical entrance)
          • If a fracture is strongly suspected, X-rays should be repeated after 2 weeks
          • Sometimes, it is just a crack fracture and is not visible on initial X-rays.
          • If no fracture is seen even at 2 weeks, no further treatment is required.
      • Treatment
          • The treatment of a scaphoid fracture is essentially conservative
          • The affected hand is immobilised in a scaphoid cast for 3-4 months. (MCQ)
          • Scaphoid cast:
            • This is a cast extending from below the elbow to the metacarpal heads, includes the thumb, up to the inter-phalangeal joint. (MCQ)
            • The "wrist is maintained in a little dorsiflexion and radial deviation (glass holding position).(MCQ)
          • In widely displaced fractures, open reduction and internal fixation using a special compression screw (Herbert’s screw) is required(MCQ)
        • Complications
          • Avascular necrosis:
            • In fractures through the waist, there is high probability of the proximal fragment becoming avascular(MCQ)
            • The patient complains of pain and weakness of the wrist
            • On the X-ray one finds non-union of the fracture with sclerosis and crushing of the proximal pole of the scaphoid.
            • Treatment:
              • If the patient is symptomatic, the avascular segment of the bone is excised
              • In some cases, the wrist develops osteoarthritis, and is treated accordingly
        • Delayed and non-union:
              • A high proportion of cases of fractures of the scaphoid go into delayed or non-union.
              • Causes of delayed or non-union
                • imperfectimmobilization
                • synovial fluid hindering the formation of fibrinous bridge between the fragments
                • impaired blood supply to one of the fragments.
              • In delayed union, the fracture, line may persist on X-ray even after 4-6 months(MCQ)
              • In non-union, distinct radiological features present are
                • roundingof the fracture surfaces
                • the fracture becomes rather sharply defined
                • cystic changes occur in one or both fragments.
              • In a late case of non-union, changes of   wrist osteoarthritis such as joint space reduction, osteophyte formation may also be seen.
              • Treatment:
                • In a case where functions are not much impaired, nothing needs to be done.
                • In a case where there is wrist pain and weakness of grip, operative intervention is necessary.
                • For delayed union, bone grafting is sufficient.
                • For non-union(MCQ)
                  • the type of operation depends upon the presence of associated osteoarthritis of the radio-carpal joint
                  • Once osteoarthritis happens, it is too late to expect relief by aiming at fracture union alone.
                  • An excision of part of the radio-carpal joint, or its fusion may be required.
          • Wrist osteoarthritis: (MCQ)
                • osteoarthritis of the wrist develop as a result  of avascular  necrosis   or  non-union.
                • In some, excision of the styloid process of the radiusis done
                • in extreme cases, wrist arthrodesis may be required.

        Scaphoid waist fracture
        Scaphoid waist fracture
        Scaphoid waist fracture
        Scaphoid pseudarthrosis
        Scaphoid pseudarthrosis
        Scaphoid pseudarthrosis, before and after treatment with Herbert screw.
        Scaphoid bone
        Scaphoid bone
        Scaphoid bone (left hand) 01 palmar view
        Scaphoid fracture
        Scaphoid fracture
        Scaphoid fracture before and after operation
        Scaphoid fracture
        Scaphoid fracture
        Scaphoid fracture before and after operation
        Carpal bones highlighted, as seen in the right hand. Proximal: A-Scaphoid B-Lunate C-Triquetrum (Triangular) D-Pisiform Distal: E-Trapezium F-Trapezoid G-Capitate H-Hamate Adjacent bones: 1-Radius (Radial bone) 2-Ulna (Elbow bone) 3-Metacarpus (Metacarpal bones)

        Scaphoid Fractures Blood Supply – Everything You Need To Know – Dr. Nabil Ebraheim
        Scaphoid Fracture: Wrist Examination

        The scaphoid is one of the small group of bones in the wrist called the carpal bones. It is the most common carpal bone to fracture among athletes and is often caused by falling onto an outstretched hand.
Initially treatment of a scaphoid bone fracture would be to apply ice or cold therapy, protect the wrist with bandaging or strapping and seek medical attention

        Percutaneous Fixation of Scaphoid Fracture
        This is a surgical video intended for patient educational purposes. The patient has given full written consent for the filming and use of this video on YouTube

        See what a scaphoid fracture looks like and hear Dr. Warhold describe a procedure that does not require casting.

        scaphoid fracture cast

        Scaphoid Fracture Diagnosis and Treatment COMLEX USMLE

        Scaphoid fixation
        Mike Hayton, Hand Surgeon, uses the Garcia-Elias approach to fix a scaphoid non union

        Plaster of Paris Scaphoid Splint Application
        Plaster of Paris is the reliable proven solution for the immobilization of fractures.

Smooth and creamy plaster formulas allow for ease of application, resulting in highly conformable natural

        Acutrak 2.0 screw for a Scaphoid Hand Fracture
        An animation for Acumed demonstrating their new line of screws for fixing fractures. This one is focused on a Scaphoid fracture in the hand.

        Broken Wrist / Scaphoid Fracture by Dr. Christopher Johnson

        VBG for Scaphoid Nonunions
        Recognizing wrist fractures, specifically scaphoid bone fractures, is especially important because of the bones’ poor blood supply. Video discusses overview of symptoms and treatment options for wrist fractures
        The scaphoid fracture is one of the most problematic fractures of the hand and wrist. This bone, located in the wrist near the base of the thumb, has a very limited blood supply that enters through a small portion of the bone. As a result, scaphoid fractures do not heal quickly and can result in a loss of blood supply that causes bone cell death, referred to as avascular necrosis. Avascular necrosis can be avoided if additional blood supply is brought in to help heal the fracture. Vascularized bone grafting involves rotation of a bone segment from the radius, a bone in the forearm, which is still attached to an artery and vein. As a result, this vascularized bone graft can bring new blood circulation into the scaphoid nonunion, the fractured area that did not heal. Internal fixation with a scaphoid screw, combined with vascularized bone grafting, can result in a 90 to 95 percent healing rate of scaphoid nonunions.

        Doctor Lawyer Discusses Dangers of a Scaphoid Fracture From An Accident
        One of the most common hand/wrist bone fractures is the scaphoid. This bone is also referred to as the navicular. Scaphos means boat like in Greek, and navi (like Navy) also refers to the bone’s ship shape. 

Small things can have a big impact and a scaphoid break is no exception. This videos explores how the bone gets broken in a car accident, where it is located, basics of diagnosis, and this unique bone’s issues with healing and recovery.

        Scaphoid Fracture

        Meet 19 year old Peter Halupka from Huntsville, Alabama. He traveled to Birmingham to have Dr. Joseph M. Sherrill of the Orthopaedic Sports Medicine Clinc of Alabama repair a fracture in his hand

        Surgical Treatment of Scaphoid Fracture Nonunion Using Internal Fixation by Houston TX Hand Surgeon

        Scaphoid Fracture

        Scaphoid Fracture Percutaneous Fixation using the Osteomed PET Device (Percutaneous Exchange Tube)