SYB 3
Marni Scheiner
Scaphoid Fracture
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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 >
distal carpal row Fx
Scaphoid Fracture
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Mechanism of injury
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Symptoms/Exam Findings
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fall on the outstretched arm with the wrist in
dorsiflexion.
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
Scaphoid Fracture
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Radiographic Findings
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Standard Radiographs
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Scaphoid View: PA with wrist in full pronation and
ulnar deviation
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PA, true lateral, and scaphoid view
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
Scaphoid Fracture
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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 (>3 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
Scaphoid Fracture
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Suspected fracture with negative plain
radiographs:
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If compressed or minimally displaced, initial
radiographs may be negative.
Traditional approach:
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immobilization followed by additional radiographs (7-10
days).
CT/MRI
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For definitive Dx in Pt can not tolerate any unnecessary
immobilization (ex. a competitive athlete)
CT scan
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more readily available
MRI
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less costly
More information about ligamentous or other possible injuries
Scaphoid Fracture
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Complications
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Malunion
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Delayed Union
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Nonunion
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*AVASCULAR NECROSIS (AVN)
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Osteonecrosis is more common in scaphoid Fx’s 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
Scaphoid Fracture
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Treatment
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If Fx displaced (≥ 1 mm) and/or significantly increased
or decreased scapholunate angle
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Non-displaced fractures (<1 mm)
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immobilize in a thumb spica splint and referred for orthopedic
evaluation.
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.