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Frx thru Waist of the Scaphoid


- Discussion:
     - 70% of carpal frx occur at waist of scaphoid (narrow part of bone);
     - 90% heal after w/ immobilization, but there is 5-10% complication rate;
     - blood supply to the proximal portion is usually intact and healing will take place if adequately reduced;
              - if nutrient artery is damaged, however, AVN may occur;
     - vertical oblique frxs are the least stable waist frx because of shear forces acting on the site of the fracture;

- Radiograph

- Treatment:
    - healing time in cast is 8-12 wks, although may require upto 18 weeks;
    - up to 90% of patients can expect union;
    - if x-rays fail to clearly demonstrate trabeculae crossing site of frx, CT scan along axis of carpal scaphoid is performed;
    - ORIF:
           - in minimally displaced fractures, expect fracture union in about 6 weeks



Patterns of union in fractures of the waist of the scaphoid.

Internal Fixation of Acute Stable Scaphoid Fractures in the Athlete.