Scaphoid fracture

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A scaphoid fracture is a scaphoid fracture in the wrist. Symptoms generally include pain in the base of the thumb that is worse with the use of the hand. The anatomical snuffbox is generally soft and swelling may occur. Complications may include nonunion fracture, avascular necrosis, and arthritis.

Scaphoid fractures are most often caused by falling on the outstretched hand. Diagnosis is generally based on medical examination and imaging. Some fractures may not be visible on plain photographs. In such cases a person can be casted with repeated X-rays within two weeks or an MRI or bone scan can be performed.

Fractures can be prevented by using a wrist protector during certain activities. In those whose fracture remains well aligned the casts are generally sufficient. If the fracture is displaced then surgery is generally recommended. Healing can take up to six months. This is the most common wrist bone fracture. Men are more affected than women.

Video Scaphoid fracture

Signs and symptoms

People with scaphoid fractures generally have tenderness tobacco boxes.

Focal pain is usually present in one of three sites: 1) the superiority of volar at the distal wrist for distal polar fracture; 2) anatomic tobacco boxes for waist or mid fractures; 3) distal to Lister tubercle for proximal polar fracture.

Maps Scaphoid fracture

Mechanism

Scaphoid fractures may occur either with direct axial compression or by wrist hypertension, such as falling on the outstretched palms (FOOSH). Using Herbert's classification system, there are three main types of scaphoid fractures. 10% -20% of the fractures are at the proximal pole, 60% -80% are in the waist (center), and the remainder occurs at the distal pole.

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Diagnosis

Scaphoid fractures are often diagnosed with PA and lateral X-rays. However, not all fractures are clearly visible at first. Therefore, people with tenderness above the scaphoid (those exhibiting pain for pressure in the anatomic tobacco box ) are often splinted on the thumb spica for 7-10 days at which the second set point of X-rays already picked up. If there is a hairline fracture, the healing will now be visible. Even then the fracture may not be visible. CT Scan can then be used to evaluate the scaphoid with a larger resolution. The use of MRI, if available, is preferable to CT and may provide an immediate diagnosis. Scintigraphic bone is also an effective method for diagnosing fractures that do not appear on Xray.

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Treatment

Scaphoid fracture treatment is guided by location in the fracture bone (proximal, waist, distal), displacement (or instability) of the fracture, and patient tolerance for cast immobilization.

Shift of the waist and fractures distal without shifts or at least have a high degree of unity with closed cast management. Short-sleeved, short-sleeve thigh or long-sleeve cast are debated in the medical literature and there is no clear consensus or evidence of the benefits of one type of casting or else has been demonstrated; although it is generally accepted to use short-sleeved spica or short-sleeve for non-displaced fractures. Non-displaced or minimally displaced fractures can also be treated with percutaneous or minimal incision surgery which, if done correctly, has a high degree of unity, low morbidity and faster activity return than closed cast management.

A more proximal fracture takes longer to heal. It is expected that the distal third will heal in 6 to 8 weeks, the middle third will take 8-12 weeks, and a proximal third will take 12-24 weeks. The Scaphoid receives its blood supply mainly from the lateral and distal branches of the radial artery. Blood flows from the upper/distal bone by retrograde to the proximal pole; if this blood flow is disrupted by a broken bone, the bones may not heal. Surgery is needed at this point to repair the bones mechanically.

Percutaneous screw fixation is recommended through a broad surgical approach as it maintains the complex of palmar ligaments and local vasculature, and helps avoid postoperative complications. This surgery includes tying the scaphoid bone back together at the most perpendicular angle possible to promote faster and stronger bone healing. During this procedure, slight excavation of the edges of the trapezium bone may be necessary to achieve the scaphoid because 80% of the bone is covered with articular cartilage, which makes it difficult to gain access to the scaphoid.

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Complications

Avascular necrosis (AVN) is a common complication of a scaphoid fracture. Since scaphoid blood supply comes from two different branches of the radial artery, fractures can limit access to the blood supply.

AVN risk depends on the location of the fracture.

• Fractures in the proximal 1/3 have a high incidence of AVN (~ 30%)
• The waist fracture in the middle of 1/3 is the most frequent fracture site and has a moderate risk of AVN.
• Fractures in the distal third are seldom complicated by AVN.

Non union may also occur from undiagnosed or untreated scaphoid fractures. The flow of arteries to the scaphoid enters through the distal pole and moves to the proximal poles. This blood supply is weak, increasing the risk of nonunion, especially with fractures in the wrist and the proximal end. If not treated properly, non-union fracture of the scaphoid may cause osteoarthritis of the wrist.

Symptoms may include pain in the wrist, decreased range of wrist motion, and pain during activities such as lifting or gripping. If the x-ray results show arthritis due to prolonged rest, the first treatment plan will focus on treating arthritis through anti-inflammatory drugs and wearing a splint when an individual feels pain in the wrist. If this treatment does not help with the symptoms of arthritis, steroid injections to the wrist may help relieve pain. If this treatment is not successful, surgery may be required.

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Epidemiology

Scaphoid fractures are common in young men. They are less common in older children and adults because the distal radius is a weaker contributor to the wrist and is more likely to be broken in this age group. Skafoid fracture account for 50% -80% of carpal injury.

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Terminology

It is also called a navicular fracture (a scaphoid also called carpal navicular), although this can be confusing with the navicular bone in the legs.

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References

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External links

• AAFP: Diagnosis and Management of Scaphoid Fractures
• Surgical Fictionation Techniques Scaphoid Fracture
• Wheeless: Scaphoid Fracture
• Avascular Necrosis blood supply from Navicular

Source of the article : Wikipedia