- Discussion:
- frx is associated w/ injury to
arterial supply of minor fragement;
- this may be manifestated by
AVN;
-
vascular supply to proximal scaphoid:
- proximal two thirds to three fourths of scaphoid is supplied by vessels entering dorsal surface;
- vessels enter thru dorsal ridge in 79 %, distal to waist in 14 %, & proximal to waist in 7 %;
- vessels branched soon after entering bone and then coursed proximally and palmarly as far as the subchondral bone;
- natural history with non operative treatment:
- times to union increasing for more proximal frx;
- frx of
distal third heal in approx 6-8 weeks;
-
middle third frx heal in 8-12 weeks;
- frx of proximal third heal in 12-23 weeks;
- Treatment:
- consider operative treatment via dorsal approach;
- consider need for cancellous bone grafting;
- Complications:
-
nonunion of proximal pole:
-
avascular necrosis of proximal pole
- Case Example:
- 20 year old male who sustained a fall on his outstretched hand;
- the fracture was missed on the initial films by the ER physician (careful review of the lateral view demonstrates the fracture);
- the second set of radiographs were taken three months later which demonstrated non union and early AVN;
Dorsal approach to scaphoid nonunion.
Management of Acute Fracture and Non Unions of the Proximal Pole of the Scaphoid. H. Krimmer. JBJS-Br. p 245-248, Volume 27, Number 3, June 2002
