9/1/2023 0 Comments Broken scaphoid![]() ![]() Where the repeat X-ray shows a fracture which was previously occult, the patient should complete 6 weeks of immobilisation.Referral to be seen in fracture clinic within 1-2 weeks with repeat X-Ray (in some areas, this may be a GP with an interest in the area).Referral to be seen in fracture clinic within 1-2 weeks (in some areas, this may be a GP with an interest in the area)Ĭlinically Suspected Scaphoid Fracture not shown on plain X-Ray.What is the usual ED management for this fracture?Ĭonfirmed Scaphoid Fracture on X-Ray or CT Most scaphoid fractures can be referred for fracture clinic review ideally in 1-2 weeks. ![]() Urgent referrals are very rarely required for scaphoid fractures, except for open injuries or dislocations. (The exception is associated with a trans-scaphoid peri-lunate fracture-dislocation - in this setting, orthopaedics should be contacted to assist with urgent reduction, ideally in theatre). Scaphoid fractures almost never require acute reduction in ED. Undisplaced fracture of distal pole of scaphoid 7. The above images show a fracture of the scaphoid tubercle The above images show a non-displaced fracture of middle third of scaphoid Scaphoid fractures are not always visible on X-ray as discussed above. ![]() If the x-ray is normal and an MRI cannot be immediately obtained, then it is generally recommended to immobilize the wrist as discussed below. If further imaging cannot be obtained in time, the patient can be treated with a plaster and followed up early with GP or fracture clinic where CT/MRI can be arranged. If x-ray is normal and clinical suspicion is high, then CT or MRI may be obtained to further rule out fracture depending on clinical situation. Plain x-ray with scaphoid-specific views is a good initial screening test, however, negative x rays do not necessarily rule out a scaphoid fracture especially if clinical suspicion is high. What Radiological Investigations should be ordered? Bruising may also be present over this areaĥ.tenderness on axial loading of the thumb caused by holding the thumb and applying force towards the 1st metacarpal.Scaphoid fractures usually occur as a result of a fall on the outstretched hand 4. Predominantly, scaphoid fractures happen in adolescents or older children. <10 years) to sustain scaphoid fractures. Scaphoid fractures are easily the most common fracture of the carpal bones. How common are they and how do they occur? How are they classified?īy location: Proximal third, Middle third, Distal third, articular surface or tubercleīy orientation: transverse, vertical or obliqueĭisplaced or non-displaced 3. Whilst immobilisation of scaphoid fractures has traditionally been in a thumb spica, there is good evidence to show that immobilisation of the wrist alone in a short-arm cast is just as effective in promoting union and preventing avascular necrosis. Mismanaged fractures can cause malunion and necrosis to the proximal end of the bone and in turn cause instability of the wrist joint. As such, fractures to this area or more proximally can cause poor outcomes if not managed appropriately. Approximately 75% of the arterial supply is from branches of the radial artery through vascular perforations on the dorsal surface near the tubercle and waist.Īs vascular supply to the proximal pole is mainly retrograde, a fracture through the waist places the proximal pole at risk of avascular necrosis. Scaphoid fractures are much more common in adolescents than younger children. The scaphoid begins ossification around the 4th year of age and may be earlier in females than males. The Scaphoid bone is one of 8 carpal bones in the wrist. What are the potential complications associated with this injury?.What is the usual ED management for this fracture?.Do I need to refer to orthopaedics now?.When is reduction (non-operative and operative) required?.What radiological investigations should be ordered?.How common are they and how do they occur?. ![]()
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