IS Case 200: Stable scaphoid waist fracture
Imaging Sciences URMC 2008
Publication Date: 2009-05-22
History
A 19-year-old male fell onto outstretched hand and had wrist pain.
Discussion
Scaphoid fractures are the most common fracture of the carpal bones. They can be subdivided into four categories. Waist fractures occur in the middle third and account for 70% of scaphoid fractures. The other 30% is divided between proximal pole, distal third and tubercle fractures. The most common clinical presentation is fall onto an outstretched hand with pain in the anatomic snuffbox.
If the fracture is identified early 90% will heal if treated correctly. Nonunion is a worrisome complication and occurs in 10-15% of scaphoid fractures. Also secondary to the blood supply to the scaphoid 15-30% will progress to avascular necrosis which usually involves the proximal pole.
If a large amount of pain is illicited on clinical examination and no fracture line is visible it is still possible that a fracture is present since up to 25% are not visible on initial radiographs. In this situation splinting and repeat imaging in 7-10 days may be recommended for further evaluation.
Once it is established that a fracture is present one must then determine if it is stable or not. Stable fractures demonstrate no displacement or movement with wrist motion and are not complete fractures. These may be treated with immobilization. Unstable fractures include displaced or angulated fractures and may involve the adjacent ligament. Movement of the fracture with wrist motion is also indicative of instability. Unstable fractures require surgery.
References
- Greenspan A. Orthopedic Imaging: A Practical Approach. 4th ed. Lippincott Williams & Wilkins, 2004.
- Wheeless CR III. Wheeless' Textbook of Orthopaedics. http://www.wheelessonline.com/ortho/frx_thru_waist_of_the_scaphoid
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