Classically there can be a pain in anatomical snuffbox which is thought to have a sensitivity of ~90% and a specificity of ~40% 4. The usual mechanism is falling on an outstretched hand with resultant hyperextension of the wrist or purely compressive force 7.
Occasionally stress fractures are also encountered although these are less common, and only usually seen in athletes (e.g. shot putters or gymnasts) 8. ClassificationPlain radiograph A dedicated plain radiographic series investigating the scaphoid exists, consisting of four projections of the scaphoid bone.
Associated scapholunate ligament disruption (Terry Thomas sign) which can be accentuated with a clenched fist view This can be on account of the rest of the wrist undergoing demineralization due to immobilization, whereas the proximal portion being bereft of blood supply retains its calcium.
Fracture location (distal pole, waist, proximal pole) involvement of articular surfaces displacement or step humpback deformity due to angulation between proximal and distal parts Importantly if no fracture is seen it is essential to recommend repeat x -rays (including dedicated scaphoid views) in 7-10 days 1.
MRI is the most sensitive modality for trabecular fractures, and this can detect completely displaced fractures, especially in the first 24 hours following injury 9,13. Nuclear medicine Although bone scans are more sensitive than plain radiograph, they are usually reserved for patients with ongoing pain despite normal serial plain films 8, 13.
Vertically oriented fracture line fragment displacement of >1 mm ligamentous instability: increased scapholunate angle (i.e. >60º or ratiocinate or capitulate angle >15º History and etymology The term scaphoid derives from the Greek word for boat.
Evidence-Based Emergency Care, Diagnostic Testing and Clinical Decision Rules. Bern JD, Chavarría G, Albaladejo F et-al. Panoramic versus conventional radiography of scaphoid fractures.
Memarsadeghi M, Breitenseher MJ, Schaefer-prokop C et-al. Occult scaphoid fractures: comparison of multi detector CT and MR imaging--initial experience. Brodie A, Baby N. Early MRI in the management of clinical scaphoid fracture.
Golfer CA, Yin Y, Villa LA et-al. Wrist fractures: what the clinician wants to know. Bridge forth G, Chef J. Lippincott's Primary Care Musculoskeletal Radiology.
Hodgkin son DW, Kurd N, Nicholson DA et-al. ABC of emergency radiology. Multi detector CT of Carpal Injuries: Anatomy, Fractures, and Fracture -Dislocations Rathachai Kali, Laura L. Avery, Ashwin V. Assani, Hand H. Abjure, Richard Sarnoff, and Robert A. Novel line Radiographic 2008 28:6, 1771-1784 13.
Bears FJ, There SJ, den Hollander P et-al. Early magnetic resonance imaging compared with bone scenography in suspected scaphoid fractures.
Aura R, XING Z, Bighorn T, Watson JT, Rostrum RF, Pray son MJ, Della Rocco GJ, Meta S, McKinley T, Wang Z, Seen KG. Surgery versus cast immobilization for adults with a bi cortical fracture of the scaphoid waist (SWIFT): a pragmatic, multigenre, open-label, randomized superiority trial Dias, Joseph J et al.
In certain circumstances further views are helpful so that the 8 overlapping bones are more easily seen. The wrist comprises the scaphoid, late, triquetral, misinform, trapezium, trapezoid, capitate and ham ate bones.
Like many other carpal injuries this fracture can have significant long term clinical consequences if not identified. There are numerous joints of the wrist, named according to their relative bones.
(OBQ06.16) A 27-year-old professional cowboy is thrown from a bull during the rodeo and lands on his hand. No deformity is identified and the hand is completely neurovascular intact.
5 Scapholunate ligament repair and percutaneous pin fixation (OBQ05.130) A 35-year-old woman reports wrist pain after a fall onto an outstretched hand.