The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. The cookie is used to store the user consent for the cookies in the category "Performance". This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other. The cookies is used to store the user consent for the cookies in the category "Necessary". The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". The cookie is used to store the user consent for the cookies in the category "Analytics". These cookies ensure basic functionalities and security features of the website, anonymously. Necessary cookies are absolutely essential for the website to function properly. Such cases can be managed with internal fixation and bone grafts, although the morbidity is high, even with surgical repair. It is particularly common in scaphoid fractures (in around 10% of cases) that go undiagnosed or are inappropriately managed. Non-union is the bone failing to heal properly, most commonly due to a poor blood supply. The most common operative technique is using a percutaneous variable-pitched screw, which can be placed across the fracture site to compress it.Īvascular necrosis is common complication of a scaphoid fracture (in around 30% of cases), with its risk increasing the more proximal the fracture. However, undisplaced fractures of the proximal pole have a high risk of AVN and surgical treatment may be advocated, particularly if it is the dominant hand of a working-age patient.Īll displaced fractures should be fixed operatively. Undisplaced fractures can typically be managed with strict immobilisation in a plaster with a thumb spica splint. The treatment of scaphoid fractures is determined by location of the fracture and degree of the fracture. Figure 3 - (A) Initial AP radiograph showing a subtle linear lucency within the scaphoid (B) more pronounced lucency observed in repeat imaging after 12 days This is the definitive investigation and, whilst it is awaited, the interim management is as for a fracture. If repeat radiographic imaging is negative, however clinical findings are still in keeping with a scaphoid fracture, an MRI scan of the wrist is indicated. Scaphoid fractures are not always detected by initial radiographs (especially undisplaced fractures) if there remains sufficient clinical suspicion, despite negative initial imaging, the patient should have the wrist immobilised in a thumb splint and repeat plain radiographs in 10-14 days for further evaluation (Fig. A “ scaphoid series” should be requested, including anteroposterior, lateral, oblique views. The main differentials of radial wrist pain following trauma are distal radial fracture, an alternative carpal bone fracture, fracture of the base of the 1 st metacarpal, ulnar collateral ligament injury, wrist sprain, or De Quervains tenosynovitis.įor suspected cases of scaphoid fracture, initial plain radiographs should be taken.
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