Background
- Most common carpal fracture (very common fracture in general)
- Most common in young men (15-30)
Mechanism
- Commonly sports injury causing extreme dorsiflexion of the wrist and pressure over the radial side of the palm (usually fall on outstretched hand)
Presentation
- Swelling over the anatomical snuffbox
- Localised tenderness over the anatomical snuffbox and scaphoid tubercle
- NB whilst this is a sign, be aware that the cutaneous branch of the radial nerve runs directly over the anatomical snuffbox so firm palpation will often elicit tenderness even in the absence of injury
- Pain is often worse on radial deviation of the wrist and on axial compression of the thumb
Investigation
- Wrist x-ray in ulnar deviation
- NB Occasionally, occult fractures may be more obvious later (1 week from presentation)
Management
- Non-displaced
- Plaster cast- ideally immobilised at 20 degrees extension
- Displaced
- Internal fixation with Kirschner wires or screw
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