🦴 Scaphoid Fractures

📊 Epidemiology

• Incidence in the UK: 12.4–29 per 100,000

• Common in young males after fall on outstretched hand (FOOSH)

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🧠 Anatomical Considerations

• Forms the floor of the anatomical snuffbox

• >80% of the surface is covered with articular cartilage, leaving minimal area for vascular entry

• Blood supply enters distally, putting proximal fractures at high risk of avascular necrosis

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⚠️ Mechanism of Injury

• FOOSH is the typical mechanism

• Fracture may involve:

  • Tubercle

  • Distal pole

  • Waist (most common)

  • Proximal pole

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📸 Diagnosis

• Initial imaging:

  • 4-view scaphoid series:

    • Posteroanterior (PA)

    • Pronated oblique

    • Ziter view (PA with ulnar deviation + 20° beam angle)

    • Lateral view

• Sensitivity in 1st week: ~80%

• If negative but suspicion remains:

  • Immobilize in thumb spica

  • Repeat imaging in 10 days

  • MRI if diagnosis remains uncertain

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🧩 Classification (by location)

1. Tubercle

2. Distal pole

3. Waist (most frequent)

4. Proximal pole

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🩺 Management

• Undisplaced distal/tubercle/waist fractures:

  • Conservative → Thumb spica cast for ~6 weeks

• Displaced waist fractures (>1–2 mm):

  • Considered unstable → Require surgical fixation

• All proximal pole fractures:

  • High risk of AVN → Surgical fixation recommended

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⚠️ Complications

• Non-union

• Avascular necrosis (especially proximal pole)

• Scapholunate ligament injury

• Wrist collapse

• Degenerative arthritis of radiocarpal joint