Ortho Dx: Wrist pain after a motorcycle accident

Scaphoid fractures are the most common of all carpal fractures. Injury is often the result of a fall on an outstretched hand with the wrist in extension. Most (80%) of the blood supply to the scaphoid is supplied via branches...

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Scaphoid fractures are the most common of all carpal fractures. Injury is often the result of a fall on an outstretched hand with the wrist in extension. Most (80%) of the blood supply to the scaphoid is supplied via branches of the radial artery that start distally and perfuse in a retrograde manner (distal to proximal). Fractures through the scaphoid can interrupt this tenuous blood supply and are prone to slow healing. Because the blood supply to the scaphoid is decreased proximally, fractures are less likely to heal as they occur more proximally. Proximal scaphoid fractures have the highest rate of nonunion. The waist is the most common location for scaphoid fractures to occur, followed by the proximal third, then the distal third.¹

In general, non-displaced, or up to 1-mm displaced, scaphoid fractures can be treated successfully without surgery. Scaphoid waist fractures are placed in a thumb spica cast for 2 to 3 months or until the fracture is healed. Healing rates of 90% with cast treatment are equal to the healing rates with surgical treatment and without the increased complication rate of surgery. Indications for surgery include proximal pole and displaced fractures. Without early recognition and treatment of scaphoid fractures, patients can develop avascular necrosis of the scaphoid, scapholunate advanced collapse, and wrist arthritis. Any suspected scaphoid fracture with normal X-rays should be either followed closely or evaluated with an MRI to avoid these potential complications.^1,2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).

References

1. Abbasi D. Scaphoid fractures. Available at: http://www.orthobullets.com/hand/6034/scaphoid-fracture (Accessed on August 8, 2017).
2. Ibrahim T, Qureshi A, Sutton AJ, Dias JJ. Surgical versus nonsurgical treatment of acute minimally displaced and undisplaced scaphoid waist fractures: pairwise and network meta-analyses of randomized controlled trials. J Hand Surg Am. 2011;36:1759-1768.