Scaphoid Fractures

Background

• Most frequently fractured carpal bone
• Accounts for almost ¾ of all carpal injuries
• Play a role in the radiocarpal joint and in the joint lying between the distal and proximal rows of carpal bones in the carpus
• A fracture occurring through the waist of the scaphoid (where the blood supply to the bone enters) may compromise blood supply and cause avascular necrosis of the proximal pole of the scaphoid

Classification

Herbert's classification:

Stable injuries (good prognosis)

• A1 - Fracture of the tubercle
• A2 - Hairline fracture through the waist

Unstable (poorer prognosis)

• B1 - Oblique fracture of the distal third
• B2 - Displaced fracture of the waist
• B3 - Proximal pole fracture
• B4 - Fractures associated with carpal dislocations
• B5 - Comminuted fractures

Mechanism of injury

• Fall onto outstretched hand (forced dorsi-flexion of the wrist)
• Palmar flexion of the wrist (3%)

Clinical Examination

• Pain on the lateral aspect of the wrist and over the anatomical snuff box
• Fullness over anatomical snuff box
• Check for deformity associated with carpus instability (Associated injury)

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