- History and Exam:
- fracture of the scaphoid is suspected w/ fall on an outstretched hand;
- snuff box tenderness (see clinical differential diagnosis:)
- scaphoid impaction syndrome
- tenderness to palpation over scaphoid tuberosity and/or proximal pole just distal to Lister's tubercle;
- limitation of wrist flexion and extension;
- tenderness w/ axial compression of thumb toward the snuff box;
- tenderness as pt supinates forearm against resistance;
- radial & ulnar deviation results in pain on radial side of wrist;
- forced dorsiflexion usually elicts significant tenderness;
Diagnosis of scaphoid fractures. A prospective multicenter study of 1,052 patients with 160 fractures.
New clinical test for fracture of the scaphoid.
Clinical fracture of the carpal scaphoid--an illusionary diagnosis.
Scaphoid tubercle tenderness: a better indicator of scaphoid fractures
- Radiographs for Scaphoid Frx:
- non diagnostic radiograph (bone scan)
- classification: tubercle, waist, or proximal 1/3;
- specific views:
- scaphoid view: (AP w/ 30 deg supination & ulnar deviation);
- pronated olblique (for the STT joint)
- lateral view
- PA of wrist w/ ulnar & radial deviation;
- any displacement that is shown at frx site indicates significant
instability, making internal fixation rx of choice;
- determination of stability; (CT scan)
- differentiate between stable and unstable acute frxs, since it appears
that former have a low incidence of complications and thus require
only minimal immobilization in plaster;
- as determined from CT or X-ray;
- > 1 mm of step off ... or...
- > 60 deg of scapholunate angulation ... or ...
- > 15 deg of lunocapitate angulation
- w/ CT Scan: PA angulation > 35 deg; or lateral interscaphoid angulation > 25 deg;
- displacement or angulation w/ radial or ulnar deviation;
- associated injuries:
- distal radius frx
- transscaphoid perilunate dislocation:
Management of displaced fractures of the waist of the scaphoid: Meta-analyses of comparative studies