Carpal Fractures -Scaphoid and Other Carpal Fractures-Carpal Fractures -Scaphoid and Other Carpal Fractures: Overview

Carpal Fractures -Scaphoid and Other Carpal Fractures: Overview

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Scaphoid fractures are a common injury that often occurs from a fall on an outstretched hand. They can be easily missed and are more commonly seen in adults in the waist region, while children tend to experience fractures in the distal third due to the ossification sequence. Scaphoid fractures can be associated with other injuries such as distal radius fractures, radial head fractures, and perilunate instability. The blood supply to the scaphoid bone is divided into two regions: the dorsal scaphoid branch of the radial artery supplying 70-80% of the bone, including the proximal pole, and the volar scaphoid branch of the radial artery supplying the tubercle to the distal scaphoid. <br /><br />To evaluate scaphoid fractures, anatomic snuffbox tenderness is observed, and if initial radiographs are negative, they may be repeated after 7-10 days. MRI can be used to detect occult fractures, while CT scans are helpful in understanding scaphoid fracture geometry and assessing union following treatment. Surgical indications include unstable fractures, displacement of 1 mm or more, fracture angulation, comminution, interscaphoid angle greater than 45 degrees, fractures in the presence of intercarpal ligament tear, proximal pole fractures, delayed presentation, and open fractures. Nonsurgical treatment involves casting for stable and nondisplaced fractures, with immobilization durations based on the fracture's location. <br /><br />Fixation options for scaphoid fractures include open reduction and internal fixation (ORIF) and percutaneous screw fixation. The choice of approach depends on the fracture location. The fixation strength is optimized with long screws placed centrally in the proximal and distal poles of the scaphoid. Complications of scaphoid fractures include avascular necrosis, nonunion, and post-traumatic arthritis. <br /><br />The evaluation and treatment of scaphoid fracture nonunions involve assessing wrist pain and stiffness, radiographs, and CT scans. Fixation options for nonunions include cancellous or structural bone grafting and internal fixation, volarly placed wedge graft for displaced scaphoid waist nonunions, and dorsal approach with inlay graft for proximal pole fracture nonunion. Salvage options for long-term scaphoid waist nonunions include excision of the distal pole of the scaphoid or scaphoid excision with intercarpal arthrodesis or proximal row carpectomy. <br /><br />The document also briefly covers other carpal fractures, such as trapezium fractures, triquetral fractures, hamate fractures, lunate fractures, trapezoid fractures, capitate fractures, and pisiform fractures. Treatment options for these fractures are discussed based on the type, displacement, and associated injuries. <br /><br />References:<br />Calfee RP, Berger R, Beredjiklian PK, Engles DR, Greenberg JA, Isaacs JE, McDaniel C, Rozenthal TD, Blazer P, Pate O. (2010). ASSH Manual of Hand Surgery. Philadelphia: Lippincott Williams & Wilkins.<br />Trumble TE, Omori D. (2017). Principles of Hand Surgery and Therapy. Philadelphia: Elsevier.<br />Rosenwasser MP, Zeltser DW. (2017). Principles of Hand Surgery and Therapy. Philadelphia: Elsevier.

Keywords

Scaphoid fractures

fall on outstretched hand

waist region fractures

distal third fractures

ossification sequence

associated injuries

anatomic snuffbox tenderness

MRI for occult fractures

surgical indications

nonsurgical treatment