![]() Pain disproportionate to the injury (suggesting compartment syndrome)Ī thorough examination of the hand and wrist should be conducted when a scaphoid fracture is suspected.Scaphoid fractures can cause median nerve damage and/or lead to avascular necrosis. It is important to ask about symptoms suggesting neurovascular injury since this is fairly common in scaphoid fractures. ![]() Social history: smoking (a risk factor for non-union), alcohol or illicit drugs (risk factors for falls), occupation (may influence management choice), physical activity and exercise (associated with higher incidence for scaphoid fracture)įor more information, see the Geeky Medics guide to the assessment, investigation and management of falls.Family history: family history of fractures and/or falls.antidepressants, diuretics, sedatives, beta-blockers) Medication history: any medications contributing to the fall (e.g.Past medical history: previous falls, previous fractures, history of osteonecrosis, co-morbidities.History of the fall: loss of consciousness, previous episodes, and/or other injuries.Clinical features of neurovascular compromise (see below).Other important areas to cover in the history include: Typical symptoms of a scaphoid fracture include: 1 However, patients may also present with a history of direct trauma to the scaphoid or after axial loading to the wrist in neutral extension-flexion. Scaphoid fractures are typically associated with a history of a fall on an ulnar-deviated, pronated, and outstretched hand. The following risk factors are associated with an increased likelihood of scaphoid non-union: 2 Scaphoid fractures are not specifically associated with other risk factors or pre-existing conditions. This can be attributed to the increased likelihood for the young male age group to engage in high-velocity activities. Male patients between 15 and 29 years have the greatest risk of fracturing the scaphoid. Herbert classification of scaphoid fractures. Unstable fractures include distal oblique fractures (B1), displaced or complete waist fractures (B2), proximal pole fractures (B3), fracture-dislocations (B4), and comminuted (B5). ![]() Tubercle fractures (A1) and incomplete waist fractures (A2) are both classified as stable. It divides acute fractures into stable (type A), unstable (type B), delayed unions (type C), and established non-unions (type D). ![]() The Herbert classification is the most commonly used classification system (Figure 1). Superficial palmar arch (branch of volar radial artery).Dorsal carpal branch (branch of radial artery): supplies 80% of blood to the scaphoid via retrograde flow.The blood supply to the scaphoid includes: The majority of scaphoid fractures involve the waist of the bone. The scaphoid can be divided into four parts: Other mechanisms include axial loading to the wrist in neutral extension-flexion or a direct blow to the scaphoid. The most common mechanism of injury is a fall on an ulnar-deviated, pronated, and hyper-dorsiflexed (outstretched) wrist. You might also be interested in our surgical flashcard collection which contains over 500 flashcards that cover key surgical topics. ![]()
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