Scaphoid Fracture PDF

SCAPHOID ANATOMY · blood supply of just below trapezium scaphoid supplied proximal by radial...

SCAPHOID ANATOMY · blood supply of just below trapezium scaphoid supplied proximal by radial artery justaborare row ↳ do getsome BS from surrounding softhoseattachmentis but BS to scaphoud is Jeurly limited AETIOLOGY Most common: falling onto an outstretched hand (FOOSH) → in particular, falling onto a radially deviated and extended wrist, with the arm fully extended Contact sports - direct contact at wrist/hand Road traffic accidents Common with gymnastics dismounts, landings # can occur in 3 places: → distal pole, proximal pole, or waist blood supply depends on Location: impacts healing time · can get different types offractures Intra-longer · What's important is if fracture extends healing into thejoint (intra-articular) or doesn't extend into joint (extra-articular) PATHOPHYSIOLOGY Blood supply from radial artery is very limited Major portion of surface covered by articular cartilage – limited areas for soft tissue attachment – limited vascularity If scaphoid is fractured at proximal This can increase risk of delayed pole, healing time increases due to non-union (fracture doesn’t heal vascularity of area together) and osteonecrosis (bone death) SIGNS & SYMPTOMS Pain in anatomical snuffbox and on directed palpation of scaphoid Pain immediately after impact - may progress to a dull ache (on radial side) Effusion within anatomical snuffbox Limitation of passive and resistive thumb/wrist extension Impaired power during hand movements Pain with direct pressure onto scaphoid with passive radial deviation Often disregarded as a sprain If you suspect scaphoid fracture, send them in for X-ray ASAP However in some cases fracture won’t show up on X-ray until around 10-14 days after initial injury → at this time, the healing process will have already started in the bone which will help the fracture site to show up → if X-ray comes back clear but they’re getting same symptoms, send them back after a week/10 days → in the meantime, put splint or brace onto wrist If patient can afford it or have private healthcare, refer them on for an MRI - most reliable for diagnosing scaphoid fracture & will also show soft tissue damage TREATMENT If non displaced, usually responds well to a cast → usually in cast for 6-12 weeks depending on site of fracture → if fracture is more proximal, will increase time in cast Recent research: after adequate conservative management, union is achieved at 6 weeks for approx 90% of non-displaced or minimally displaced (/=1.5mm (Clementson 2020) screws or pins to Rehab once out of cast: secure & make that fracture stable to Decrease swelling improve healing time Increase ROM particularly in pronation & supination Increase strength - isometrics, isotonic, weight bearing Need to get radiographic imaging before RTP to ensure complete union - especially when patient still in pain