Scaphoid Fracture

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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