SYB 3

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SYB 3

• Marni Scheiner

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(No Transcript)
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Scaphoid Fracture

• Most common type of wrist fracture
• Location Radial aspect of the hand just distal
  to the radius itself
• 65 at the waist
• 15 proximal pole
• 10 distal body
• Results mainly from a fall on an outstretched arm
• proximal carpal row Fx gt distal carpal row Fx
• http//ptclinic.com/medlibrary/images/v2/ScaphoidF
  racture.gif

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Scaphoid Fracture

• Mechanism of injury
• fall on the outstretched arm with the wrist in
  dorsiflexion.
• Symptoms/Exam Findings
• History of fall/trauma
• Pain localized to radial aspect of wrist
  (anatomic snuffbox) increased with palpation
• Dorsoradial swelling
• ROM and grip strength reduced
• Any tenderness in the snuffbox should be treated
  as a scaphoid fracture until proven otherwise

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Scaphoid Fracture

• Radiographic Findings
• Standard Radiographs
• PA, true lateral, and scaphoid view
• Scaphoid View PA with wrist in full pronation
  and ulnar deviation
• Shows scaphoid in its most longitudinal axis
  separates it on radiograph from shadows of the
  distal radius.
• If questionable Fx alignment on plain
  radiographs, an MRI or CT scan should be obtained
  to correctly identify the amount of displacement

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Scaphoid Fracture

• Should evaluate for signs of ligament disruption
  (esp scapholunate ligament).
• "Terry Thomas Sign
• Normal space b/w scaphoid and lunate bones
  1-2mm
• Terry Thomas Sign
• widened space (gt3 mm) between the scaphoid and
  the lunate
• accentuated in PA of closed hand in a fist with
  ulnar deviation
• important since it is a cause of chronic wrist
  pain and disability if left untreated.
• www.rcsed.ac.uk/.../hand/scapholunate_diss.htm

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Scaphoid Fracture

• Suspected fracture with negative plain
  radiographs
• If compressed or minimally displaced, initial
  radiographs may be negative.
• Traditional approach
• immobilization followed by additional radiographs
  (7-10 days).
• CT/MRI
• For definitive Dx in Pt can not tolerate any
  unnecessary immobilization (ex. a competitive
  athlete)
• CT scan
• more readily available
• MRI
• less costly
• More information about ligamentous or other
  possible injuries

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Scaphoid Fracture

• Complications
• Malunion
• Delayed Union
• Nonunion
• AVASCULAR NECROSIS (AVN)
• Osteonecrosis is more common in scaphoid Fxs
  than most other bones 15-30 of all scaphoid
  fractures
• most commonly involves the proximal pole
• blood supply runs from distal to proximal leading
  to the possibility of non-union or osteonecrosis
  of the proximal pole

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Scaphoid Fracture

• Treatment
• If Fx displaced ( 1 mm) and/or significantly
  increased or decreased scapholunate angle
• immobilize in a thumb spica splint and referred
  for orthopedic evaluation.
• Non-displaced fractures (lt1 mm)
• short-arm thumb-spica cast typically for six to
  10 weeks. Fractures at the waist or proximal
  third could be given more substantial
  immobilization in a long-arm cast.
• If immobilization is not an option, operative
  fixation is suggested.
• Athletes rigid protection for 2 months after
  radiographic healing.