scaphoid fracture
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Pathology
- the scaphoid has a poor blood supply & does not heal well
History
- generally patients have a history of injury associated with dorsiflexion at the wrist (falling on an outstretched hand)
Clinical manifestations
- pain & tenderness in the anatomical snuff box
Radiology
- rarely displaced & generally not visible on initial radiographs
- follow-up X-ray in 2 weeks
- bone scan for persistent pain (> 2 weeks) with negative X-ray
- magnetic resonance imaging has 100% sensitivity[2]
- more cost effective than waiting 2 weeks for follow-up X-ray when lost productivity considered[1]
* image[2]
Complications
- avascular necrosis of proximal scaphoid[2]
- almost always associated with injury to ligament attachments[2]
Differential diagnosis
Management
- splint immobilization of the wrist
- if clinical suspicion is high, immobilization even if radiographs are normal[1]
- indications for surgery