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SYB 3

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... longitudinal axis; separates it on radiograph from shadows of the distal radius. If questionable Fx alignment on plain radiographs, an MRI or CT scan should be ... – PowerPoint PPT presentation

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Title: SYB 3


1
SYB 3
  • Marni Scheiner

2
(No Transcript)
3
Scaphoid Fracture
  • Most common type of wrist fracture
  • Location Radial aspect of the hand just distal
    to the radius itself
  • 65 at the waist
  • 15 proximal pole
  • 10 distal body
  • Results mainly from a fall on an outstretched arm
  • proximal carpal row Fx gt distal carpal row Fx
  • http//ptclinic.com/medlibrary/images/v2/ScaphoidF
    racture.gif

4
Scaphoid Fracture
  • Mechanism of injury
  • fall on the outstretched arm with the wrist in
    dorsiflexion.
  • Symptoms/Exam Findings
  • History of fall/trauma
  • Pain localized to radial aspect of wrist
    (anatomic snuffbox) increased with palpation
  • Dorsoradial swelling
  • ROM and grip strength reduced
  • Any tenderness in the snuffbox should be treated
    as a scaphoid fracture until proven otherwise

5
Scaphoid Fracture
  • Radiographic Findings
  • Standard Radiographs
  • PA, true lateral, and scaphoid view
  • Scaphoid View PA with wrist in full pronation
    and ulnar deviation
  • Shows scaphoid in its most longitudinal axis
    separates it on radiograph from shadows of the
    distal radius.
  • If questionable Fx alignment on plain
    radiographs, an MRI or CT scan should be obtained
    to correctly identify the amount of displacement

6
Scaphoid Fracture
  • Should evaluate for signs of ligament disruption
    (esp scapholunate ligament).
  • "Terry Thomas Sign
  • Normal space b/w scaphoid and lunate bones
    1-2mm
  • Terry Thomas Sign
  • widened space (gt3 mm) between the scaphoid and
    the lunate
  • accentuated in PA of closed hand in a fist with
    ulnar deviation
  • important since it is a cause of chronic wrist
    pain and disability if left untreated.
  • www.rcsed.ac.uk/.../hand/scapholunate_diss.htm

7
Scaphoid Fracture
  • Suspected fracture with negative plain
    radiographs
  • If compressed or minimally displaced, initial
    radiographs may be negative.
  • Traditional approach
  • immobilization followed by additional radiographs
    (7-10 days).
  • CT/MRI
  • For definitive Dx in Pt can not tolerate any
    unnecessary immobilization (ex. a competitive
    athlete)
  • CT scan
  • more readily available
  • MRI
  • less costly
  • More information about ligamentous or other
    possible injuries

8
Scaphoid Fracture
  • Complications
  • Malunion
  • Delayed Union
  • Nonunion
  • AVASCULAR NECROSIS (AVN)
  • Osteonecrosis is more common in scaphoid Fxs
    than most other bones 15-30 of all scaphoid
    fractures
  • most commonly involves the proximal pole
  • blood supply runs from distal to proximal leading
    to the possibility of non-union or osteonecrosis
    of the proximal pole

9
Scaphoid Fracture
  • Treatment
  • If Fx displaced ( 1 mm) and/or significantly
    increased or decreased scapholunate angle
  • immobilize in a thumb spica splint and referred
    for orthopedic evaluation.
  • Non-displaced fractures (lt1 mm)
  • short-arm thumb-spica cast typically for six to
    10 weeks. Fractures at the waist or proximal
    third could be given more substantial
    immobilization in a long-arm cast.
  • If immobilization is not an option, operative
    fixation is suggested.
  • Athletes rigid protection for 2 months after
    radiographic healing.
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