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Scaphoid Fracture

Scaphoid Fractures


Presentation

  • This surgery requires a prolonged period in a splint or cast afterwards, and there is a reasonable risk that your fracture will not heal after surgery, as the blood supply to the fracture is not universally present.[murdochorthopaedic.com.au]
  • When this occurs, they will typically present with complaints of persistent pain and swelling.[ncbi.nlm.nih.gov]
  • Summary Scaphoid fractures are a particularly challenging wrist injury, as they often manifest the identical presentation as a wrist sprain.[ncbi.nlm.nih.gov]
  • However, because of the diagnostic challenge that scaphoid fractures often present, the exact incidence is unknown.[ncbi.nlm.nih.gov]
  • Focal tenderness is usually present in one of three places: 1) volar prominence at the distal wrist for distal pole fractures; 2) anatomic snuff box for waist or midbody fractures; 3) distal to Lister's tubercle for proximal pole fractures. [4] Complications[en.wikipedia.org]
Asymptomatic
  • Pseudo-arthrosis often remains asymptomatic, and may become evident and symptomatic in case of a new trauma or in case of excess strain of the wrist joint.[ncbi.nlm.nih.gov]
Rigor
  • However, the rigors of military life may approximate the upper extremity demands seen in sport. In 2001, a prospective, randomised study of U.S.[aspetar.com]
Inflammation
  • Unlike the aforementioned techniques this particular imaging study can be used to evaluate osteoblastic activity and inflammation as a means of diagnosing a scaphoid fracture [ 8 ].[ncbi.nlm.nih.gov]
Contusion
  • MRI is better for identifying concomitant ligamentous injuries and altered scaphoid vascularity, but may be overly sensitive in diagnosing scaphoid contusions as fractures.[aspetar.com]
Fear
  • The fear of litigation for missing or mistreating this injury has lead to many of these patients with painful wrists being over-treated.[ncbi.nlm.nih.gov]
Distractibility
  • Distraction may lead to nonunion 39, 40 and translation may occur if the screws are placed eccentrically in either fragment. Rotation of the fragments during tightening of the screw may be countered using a derotation wire.[online.boneandjoint.org.uk]
Rabies
  • Radiologe. 1997; 37 (10):812–8. [ PubMed ] [ Google Scholar ] Brydie A, Raby N. Early MRI in the management of clinical scaphoid fracture.[ncbi.nlm.nih.gov]
  • Low G, Raby N. Can follow-up radiography for acute scaphoid fracture still be considered a valid investigation? Clin Radiol. 2005; 60 :1106–1110. [ PubMed ] [ Google Scholar ] 5. Dorsay TA, Major NM, Helms CA.[ncbi.nlm.nih.gov]
  • Low G, Raby N. Can follow-up radiography for acute scaphoid fracture still be considered a valid investigation? Clin Radiol. 2005; 60 :1106–1110. doi: 10.1016/j.crad.2005.07.001. [ PubMed ] [ CrossRef ] [ Google Scholar ] 7.[ncbi.nlm.nih.gov]
Neglect
  • With these issues in mind, I propose the following algorithm: All proximal pole fractures, displaced scaphoid waist ( 1 mm), combined injuries and fractures that were neglected for more than 1 month should be repaired without second thought.[aspetar.com]
Confusion
  • […] more likely to fracture in these age groups. [7] Scaphoid fractures account for 50%-80% of carpal injuries. [5] Terminology [ edit ] These are also called navicular fractures (the scaphoid also being called the carpal navicular), although this can be confused[en.wikipedia.org]

Treatment

  • Treatment of scaphoid fractures. Operative treatment With improved, minimally invasive surgical techniques, surgical treatment of non-displaced scaphoid fractures has increased.[ncbi.nlm.nih.gov]
  • […] of nonunion, malunion, infection, or complications or total treatment cost.”[aspetar.com]
  • Treatment options for a non-displaced scaphoid waist fracture must be discussed with the patient. Treatment with cast immobilization is not without consequences.[ncbi.nlm.nih.gov]
  • Scaphoid Fracture Treatment Undisplaced Scaphoid Fractures If the fracture is not displaced and is in the waist or distal pole, the treatment of the fracture by a splint or cast until the fracture heals may be suitable.[murdochorthopaedic.com.au]
  • If these treatments do not help the symptoms of arthritis, steroid injections to the wrist may help alleviate pain.[en.wikipedia.org]

Prognosis

  • Examination, X-rays, MRI, bone scan [2] Differential diagnosis Distal radius fracture, De Quervain's tenosynovitis, scapholunate dissociation, wrist sprain [2] [1] Prevention Wrist guards [1] Treatment Not displaced : Cast [2] Displaced : Surgery [2] Prognosis[en.wikipedia.org]
  • Operative treatment Fractures resulting in decreased prognosis for healing include fracture displacement, concominant carpal ligament instability (DISI deformity), and delayed presentation greater than 4 weeks [ 15 ].[ncbi.nlm.nih.gov]

Epidemiology

  • During this procedure, slight excavation of the edge of the trapezium bone may be necessary to reach the scaphoid as 80% of this bone is covered with articular cartilage, which makes it difficult to gain access to the scaphoid. [12] Epidemiology [ edit[en.wikipedia.org]
  • Epidemiology of hand injuries in sports. In: Strickland JW, Rettig AC, editors. Hand injuries in athletes. Philadelphia: WB Saunders; 1992. pp. 37–48. [ Google Scholar ] 4. Weber ER, Chao EY.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Prevention

  • Proximal, medial, distal [2] Causes Fall on an outstretched hand [2] Diagnostic method Examination, X-rays, MRI, bone scan [2] Differential diagnosis Distal radius fracture, De Quervain's tenosynovitis, scapholunate dissociation, wrist sprain [2] [1] Prevention[en.wikipedia.org]
  • Imaging to monitor the progress of scaphoid healing is often necessary to prevent or promptly treat developing complications.[ncbi.nlm.nih.gov]
  • Anatomical fracture reduction and intra-articular alignment will prevent an early arthrosis. Several operational techniques have been described.[ncbi.nlm.nih.gov]
  • Displaced scaphoid fractures should be reduced and stabilized surgically to prevent the risk of malunion or nonunion. Many operative techniques have been described to treat scaphoid fractures.[ncbi.nlm.nih.gov]
  • Lynch and Linscheid 45 reviewed five corrective patients who had undergone an osteotomy between 1.5 and 19 years late and found improvements in grip strength but correction did not prevent the development of osteoarthritis.[online.boneandjoint.org.uk]

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