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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