scaphoid fracture in short..taught by my sir

1. S C A P H O I D F R A C T U R E
G O P I S A N K A R . M . G
Case discussion

2. Scaphoid
 A commonly fractured bone
 Most common congenitally absent bone
 Visible and palpable part is tuberosity of scaphoid in
anterior aspect of wrist
 It is more visible dorsiflexion and radial deviation of
wrist why because scaphoid undergoes flexion at this
position

3.  Disappears on flexion and ulnar deviation as it
extends

4.  The above reasons explain why falling on out
strectched hand produces this fracture
 As when we fall--- keeps the wrist in dorsiflexion
and radial deviation
 Actually it also depends on (that is fracture) angle
between the forearm and wrist
 When that angle is around 90 degree we fall on the
tuberosity directly

5.  If angle is at 60 degree u get????
 Distal fracture colles fracture
 If angle less than that ie less than 60 degree u may
get forearm bones fracture radius or ulna
 Thus mechanism of injury is very important

6.  Scaphoid means “boat shaped”
 70 percent of the bone is covered by articular
cartilage
 Rest by bone

7.  Blood supply is via radial artery
 Two grops volar and dorsal
 Volar supplies the scaphoid tubercle
 Dorsal  supply is from distal to proximal so
proximal pole is not getting direct blood supply
 So in fracture it can undergo AVN (avascular
necrosis)

8. Parts of scaphoid
 Proximal pole(AVN chance)
 Waist (most common site of fracture)
 Distal pole
 Tuberosity

9. Diagnosis
 clinical
 often missed
 suspect when falls on out stretched hands

10. Signs
1. Tenderness in the anatonical snuff box
 As floor of the snuff box is formed by the scaphoid
and trapezius bone

11.  2. Axial compression on the thumb produces pain
 3. Pronate against resistance causes pain

12. Xray AP,Lat ,Oblique
 View in ulnar deviation an undisplaced fracture can
be found
 but Xrays may be negative for first two weeks
 Other options  isotope bone scan Tc 99
 MRI
 3D CT scan

13. Management
 Undisplaced plaster
 Scaphoid cast  glass holding position extends upto
distal transverse crease in other fingers
 On thumb upto base of P2
 Casts for a minimum of 6 weeks
 Take xray

14. If displaced
 Better to cannulate the bone unde C arm guidance
 Or can do open reduction
 Implant is Herbert’s screw it is a cannulated screw
and a handleless screw
 With differential pitch that is thread size on one end
is not similar to another

15.  We put it from distal to proximal
 Distal is bigger thatn proxiamal
 After Herebert’s screw  3 months immobilisation

16. When will u call as nonunion
 After 4 months if not united
 More with conservatuve management
 In displaced fracture

17. xray
 Proximal fragment sclerosis
 Can excise it if it is less than 20% of total area of
scaphoid
 If big can do bone grafting
 Vascularised graft

18. Graft options
1. Take a free vascularised bone graft ---take a bone
graft with blood supply and anastomosis
2. Take a piece of bone with muscle and intact BS
---pronator quadratus and radius and put into
scaphoid

19.  If neglected
 SNAC  Scaphoid Nonunion Asdvanced Collpase
 Secondary osteoarthritis
 Finally may have to wristy arthrodesis at 30 degree
flexion

20. Thanku