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scaphoid fracture
History:
- generally patients have a history of injury associated with dorsiflexion at the wrist (falling on an outstretched hand)
Pathology:
- the scaphoid has a poor blood supply & does not heal well
Clinical manifestations:
- pain & tenderness in the anatomical snuff box
Radiology:
1) rarely displaced & generally not visible on initial radiographs
2) follow-up X-ray in 2 weeks
3) bone scan for persistent pain (> 2 weeks) with negative X-ray
4) magnetic resonance imaging has 100% sensitivity [2]
- more cost effective than waiting 2 weeks for follow-up X-ray when lost productivity considered [1]
* image [2]
Complications:
- avascular necrosis of proximal scaphoid [2]
- almost always associated with injury to ligament attachments [2]
Differential diagnosis:
- distal radius fracture
Management:
1) splint immobilization of the wrist
2) if clinical suspicion is high, immobilization even if radiographs are normal [1]
3) indications for surgery
- proximal fractures
- non-union of fracture [2]
Related
scaphoid bone (navicular bone of hand)
wrist & hand pain
General
hand fracture
References
- Medical Knowledge Self Assessment Program (MKSAP) 11,16,19
American College of Physicians, Philadelphia 1998,2012, 2021.
- Cimino-Fiallos N
14 Can't-Miss Hand Emergencies
Medscape. March 5, 2021
https://reference.medscape.com/slideshow/hand-emergencies-6010180