However, if pain and swelling dont go away, doctors become suspicious that the injury is actually more serious. However, despite optimal treatment, complications may ensue. A fall on an outstretched hand commonly breaks the scaphoid bone of the. The scaphoid bone is located at the base of the hand, below the the thumb tendons. Scaphoid fractures are commonly seen in orthopedic practice. The surgeon finds the old fracture line on the scaphoid bone. If a scaphoid fracture does not heal, it is called a scaphoid fracture nonunion. The anatomy of wrist, thumb and hand is complex because of. The clinical signs of a scaphoid fracture were swelling and tenderness in the anatomical snuff box. Apr 23, 2017 indications the scaphoid fracture test is a wrist examination procedure that determines the existence of a scaphoid fracture. The sagittal images parallel to the long axis of the scaphoid obtained from ct scans provide the best view for determining the extent of collapse.
The scaphoid is the only carpal bone to cross the proximal and distal rows and acts as a strut between them. Scaphoid fracture orthopedic specialists of seattle. Feb 23, 2017 and arthroscopic assisted scaphoid screw insertion, volar and dorsal vascularized scaphoid bone grafts, and more this highly practical clinical reference is an indispensable resource for every resident, fellow, or clinician in hand surgery, orthopedic trauma surgery, or plastic surgery. The scaphoid is involved with almost all movement of the hand and wrist. The scaphoid bone is the largest bone of the proximal row of wrist bones, its long axis being from above downward, lateralward, and forward.
Acute fractures of the scaphoid northwestern university. Scaphoid fractures that are closer to the thumb distal pole usually heal in a matter of weeks with proper protection and restricted activity. The first xray taken may be normal and the fracture may only become apparent on xrays taken 10 14. Imaging studies show displacement, resorption at the fracture site, and sometimes cyst formation fig. The scaphoid bone is one of the carpal bones on the thumb side of the wrist, just above the radius. Types of joints synovial diarthroidal freely movable cartilagenous amphiarthroidal slightly movable fibrous synarthroidal immovable. This type of fracture occurs most often after a fall onto an outstretched hand. Advantages provides good exposure of the scaphoid bone. Procedure the patient should be awake and cooperative when the scaphoid fracture test is done.
Symptoms typically include pain and tenderness below the base of the thumb in an area known as the anatomic snuffbox. Scaphoid fracture is common in orthopedics, ac counting for 71. Featuring insights from pioneers in the field, its comprehensive coverage extends from standard open procedures to stateoftheart. Patterson, phd, hisao moritomo, md, satoshi yamaguchi, md, hiromichi mitsuyasu, md, phd, munir shah, md, william l. Breaks are often caused during falls or as a result of repeated use of the wrist in sports such as skiing. The chart showing pdf series, word series, html series, scan qr codes. The scaphoid is a small bone, with a large articular surface. There is a prominent bony bulge on the back surface of the lateral side of the distal pole, known as the scaphoid tubercle 3 the scaphoid articulates with four of the wrist bones the lunate, capitate. Scaphoid wrist bone fracture orthopedic specialists of. Diagnosis of scaphoid fracture and dedicated extremity mri article pdf available in acta orthopaedica scandinavica 705. Current methods of diagnosis and treatment of scaphoid fractures.
The dorsal branch of the radial artery provides 75% of the blood supply through the foramina. Scaphoid bone definition, location, anatomy, diagram. The scaphoid can be slow to heal because of the limited circulation to the bone. Ct provides the most precise definition of the osseous anatomy. The scaphoid is the largest of the proximal row of carpal bones and sits on the radial side of the lunate. It sits on the radial or lateral side of the wrist near the thumb. The scaphoid bone serves as a bridge between the carpal bones close to the forearm and the carpal bones close to the hand, and helps to maintain carpal stability. Because symptoms can be minimal, scaphoid fractures are frequently mistaken as sprained wrists. Your digital gateway to expertise, education, and innovation. Fractures of the scaphoid must be recognized and treated quickly, as prompt treatment by immobilization or surgical fixation increases the likelihood of the bone healing in anatomic alignment, thus avoiding malunion or nonunion. Treatment for a scaphoid fracture can range from casting to surgery, depending on the fractures severity and location on the bone. Nonunions are mostly treated operatively by restoring the anatomy to avoid degenerative wrist arthritis. Diagnosis of scaphoid fracture and dedicated extremity mri. Current methods of diagnosis and treatment of scaphoid.
It is situated between the hand and forearm on the thumb side of the wrist also called the lateral or radial side. Volar approach to the scaphoid orthopaedicsone articles. On surface anatomy, the scaphoid is located below the anatomic snuffbox figure 2. During radial deviation and dorsiflexion of the wrist, the scaphoid encroaches on the radius, limiting this motion. Adequate treatment of scaphoid fractures can result in high rates of. Though not always easily noticed, a scaphoid fracture can have serious longterm consequences if.
It is a boatshaped bone that is oriented obliquely with its long axis aligned from the medial portion of the distal radius proximally to the articulation of the 1 st and 2 nd metacarpals distally the scaphoid can be divided into proximal and distal poles. Anatomy and mechanism of injury the greek term scaphoid skiff or boat is usually thought to be preferable to the latin term carpal navicular. In the setting of nonunion or an avascular proximal pole, vascularized bone grafting may be needed. The scaphoid is a small bone located on the thumb side of your wrist. Scaphoid facture durango, co scaphoid facture treatment. Because of its complex anatomy, treating scaphoid fractures and nonunions can be challenging and difficult to detect. Anatomy and biomechanics the scaphoid is a biomechanically important. Pain to palpation is a slightly less sensitive but more specific finding for detection of scaphoid fractures.
The scaphoid fracture was first described in 1905 by destot, a french surgeon, anatomist and radiologist. A nondisplaced scaphoid fracture could thus be incorrectly diagnosed as a sprain because the xray was negative. The proximal surface of the scaphoid is convex and articulates with the scaphoid from the department of orthopaedic surgery and rehabilitation, the fossa of. Delee and drezs orthopedic sports medicine principles and practice, 3rd ed, saunders, philadelphia 2010. This wrist bone resembles a medium cashew in size and shape 7, with the two sides identified as the distal and proximal poles. It can most easily be identified when the thumb is held in a hitchhiking position. Functional anatomy of the hand and wrist common sports injuries daryl c. Mfc bone graft for scaphoid nonunion, osteonecrosis, and. Scaphoid fractures musculoskeletal medicine for medical. Leaves a more cosmetic scar than the dorsal approach. Scaphoid fracture typically from a fall onto an outstretched hand foosh young patient as opposed to most distal radius fractures may initially seem relatively benign delayed presentation not uncommon because patient not seeking treatment or missed at initial presentation. An improperly treated scaphoid fracture can result in significant wrist pain, arthritis, and loss of motion. Weiland, md at the orthopedic trauma service of hospital for special surgery. Scaphoid fracture test orthopaedic examination of the wrist.
A scaphoid fracture most commonly results from a fall on an outstretched hand. The scaphoid bone is one of the eight carpal bones of the wrist you can check out this doodle for a refresher the scaphoid is the most commonly fractured carpal bone, accounting for almost 70% of fractures. Diagnosis and management of scaphoid fractures american. May 04, 2017 the anatomy of the scaphoid presents a unique challenge when dealing with injury. Research has shown that the use of mri is effective to determinate a scaphoid fracture. Nondisplaced proximal, medial, and displaced fractures warrant referral to an orthopedic subspecialist. It tends to be young males who break their scaphoid this is both an anatomical thing.
The word scaphoid is derived from the greek word for boat skaphos. Avoids damaging the dorsal blood supply to the bones proximal half, as well as the superficial branch of the radial nerve. Scaphoid fractures are the most common carpal fractures, about which debate continues. The bone is important for both motion and stability in the wrist joint. Aug 15, 2018 mfc bone graft for scaphoid nonunion, osteonecrosis, and failed prior surgery. The scaphoid is vitally important for the proper mechanics of wrist function. Anatomic snuffbox pain has a sensitivity of 90% and specificity of 40% for detection of scaphoid fractures.
Scaphoid fracture of the wrist atlantic orthopaedic. A 34yearold male fell while snowboarding onto his outstretched right upper extremity and radiographs revealed a rightsided scaphoid fracture. If you are tender directly over the scaphoid bone which is located in the hollow at the thumb side of the wrist as shown in figure 2, your health care provider might recommend wearing a splint to be safe. Eighty percent of the scaphoid bone consists of cartilage, leaving limited space for entrance of the supplying arteries. Scaphoid fractures central coast orthopedic medical group. The scaphoid is located on the thumb side of the wrist, in the area where the wrist bends see figure 1. Feb 04, 2011 proximal scaphoid fractures and displaced scaphoid fractures have a worse outcome and might be better off with an open or closed reduction and internal fixation. The scaphoid bone is a small, boatshaped bone in the wrist, which, along with 7 other bones, forms the wrist joint. The scaphoid bone is one of the carpal bones of the wrist. Pdf various classifications of scaphoid fractures have been based on plain radiography, but there are difficulties. The ulnar collateral ligament, between the styloid process of the ulna and the triquetral and pisiform bones, is under tension during radial deviation of the hand.
A break in the bone that cannot be seen on xray yet is called an occult fracture. Pa view of right wrist, case 2, 26 months after injury. Severe degeneration of the scaphoid has occurred, resulting in socalled slac wrist. Limited open approach for dorsal fixation of scaphoid fractures 11. The word scaphoid comes from the greek term for boat. Its unique morphology from its boat like shape to its retrograde blood supply can present with challenges in the presence of a fracture. Pdf this thesis deals with current issues in anatomy, diagnosis and. Scaphoid fracture test orthopaedic examination of the. Pdf knowledge of anatomy is a necessary prerequisite to assess and plan the means and methods to deal with traumatic wrist injuries. Magnetic resonance imaging or bone scintigraphy may be useful if the diagnosis remains unclear after. A fracture of the scaphoid bone usually occurs from a. Because of its unique anatomy it can articulate with all five surrounding bones distal radius, os capitatum, os lunatum, os trapezium and os trapezoideum.
The incidence of scaphoid nonunions has been reported to be between 5 and 15%. Doctors commonly diagnose a sprained wrist after a patient falls on an outstretched hand. The scaphoid is one of the small bones in the wrist carpal bones, and the one that is most likely to break. The main blood supply is through retrograde branches of the radial artery. Chief of sports medicine, orlando health chief medical officer, orlando city soccer club orthopedic institute thank you dr. Three strikes but not necessarily out commentary on an article by nicholas pulos, md, et al free vascularized medial femoral condyle bone graft after failed scaphoid nonunion surgery boyer, martin i. Jul 20, 2006 the screw holds the scaphoid firmly until it heals. It is a boatshaped bone that is oriented obliquely with its long axis aligned from the medial portion of the distal radius proximally to the articulation of the 1 st and 2 nd metacarpals distally. By university of washington featuring thomas trumble.
Characteristics of synovial joints articular end plate a thin layer of compact bone over the spongy bone covering the ends of the bones articular hyaline cartilage for shock. Md jaaos journal of the american academy of orthopaedic surgeons. It is a very important stabiliser of the mid carpal joint it is also the most commonly injured wrist bone. The patient presents with pain, loss of motion, often local tenderness, and snuff box fullness. A scaphoid fracture, one of the most common types of wrist fractures, is a break in the scaphoid bone. Because portions of the scaphoid have a poor blood supplyand a fracture can further disrupt the flow of blood to the bonecomplications with the. Featuring insights from pioneers in the field, its comprehensive coverage extends from. Apr 14, 2015 the scaphoid is a carpal bone in the wrist. Anatomic measurement of wrist scaphoid and its clinical significance.
Scaphoid fractures of the proximal or distal pole usually prevent adequate fragmentary screw purchase and, consequently, are not suitable to plate fixation. Indications the scaphoid fracture test is a wrist examination procedure that determines the existence of a scaphoid fracture. The scaphoid is located on the thumb side of the wrist, in the area where the wrist bends. Scaphoid fracture is a break in the scaphoid bone, one of the small bones in your wrist. An organized and thoughtful approach to diagnosis and treatment can facilitate good outcomes. The anatomy and biomechanics of the wrist are discussed in detail separately. The scaphoid is the most commonly fractured carpal. Indepth coverage of scaphoid surgery from the worlds leading authorities. She subsequently underwent a proximal row carpectomy for chronic pain. Scaphoid bone anatomy and fractures sketchy medicine. Do you want to use the redesigned ao sr like an app. A patients guide to scaphoid fracture of the wrist introduction. Therefore, there are some situations where plating will be difficult or contraindicated.
Its anatomy has been described in detail by many authors. The scaphoid is the most common bone to break or fracture from a wrist injury. The scaphoid, one of the most important bones in the wrist, has a limited blood supply. Scaphoid fracture is a common injury encountered in family medicine. The scaphoid is the most important carpal wrist bone. Almost completely covered with articular cartilage, this creates precise surface loading demands and intolerance to bony remodeling. Mfc bone graft for scaphoid nonunion, osteonecrosis, and failed prior surgery. Scaphoid fractures southern california orthopedic institute. Section i anatomy and imaging chapter 1 scaphoid anatomy. Scaphoid fracture in the elite athlete hand surgery, pc.
Anatomy and biomechanics the scaphoid is a biomechanically important, boatshaped carpal bone from the greek skaphos, meaning boat that articulates with the distal radius, trapezium, and capi tate. It has been shown to have 100% sensivity and 98% specificiteit for scaphoid fractures compared with only 64% for plain radiography. The scaphoid bone resembles a boat with its relatively long, curved shape. When you hold your thumb in a hitch hiking position, the scaphoid is at the base of the depression made by your thumb tendons. An incision is made in the wrist directly over the scaphoid bone. Description the scaphoid is one of the small bones in the wrist carpal bones, and the one that is most likely to break. If pain persists, a followup exam and xray in a week. A scaphoid fracture is a break in one of the small bones of the wrist. Each chapter covers a different procedure, beginning with a discussion of relevant anatomical. The anatomy of the scaphoid presents a unique challenge when dealing with injury.
A scaphoid fracture is commonly caused by a fall on an outstretched hand, with significant weight landing on the palm. Whether the main issue is carpal collapse and humpback deformity in an. For this type of fracture, your doctor may place your forearm and hand in a cast or a splint. In cases where a nonunion has occurred depite wearing a cast and using an electrical stimulator, surgery will likely be suggested. A fall on an outstretched hand commonly breaks the scaphoid bone of the wrist. Scaphoid fractures can be difficult to treat for a variety of reasons 1. It is present on the thumb side of the wrist, and is at a high risk for fractures. The scaphoid is located at the base of the thumb, just above the radius bone. The radial collateral ligament, between the styloid process of. It is also the bone in the wrist that is most often injured, especially among athletes. This part of the scaphoid bone has a good blood supply, which is necessary for healing. The scaphoid is one of eight bones that form the complex part of the human body we know as the wrist. A scaphoid fracture is usually seen in young men aged 20 to 30 years. There is a number of unanswered questions, concerning such issues as scaphoid vascularity, anatomy, clinical and radiological diagnosis, and treatment options.
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