OrthopaedicPrinciples.com

Integrating Principles and Evidence

Integrating Principles and Evidence

  • Home
  • Editorial Board
  • Our Books
    • Evidence Based Orthopaedic Principles
  • Courses
  • Exams
  • Reviews
  • Live Program
  • Contact

Scaphoid Fractures

Courtesy:Dr Sudhir Warrier, President Bombay Orthopaedic Society

SCAPHOID FRACTURE

BLOOD SUPPLY

  • Comes from distal to proximal
  • Dorsal vessels >volar vessels
  • Any fracture at waist/proximal to waist is at great danger of avascular necrosis of the proximal pole of the scaphoid

CLASSIFICATION

HERBERT’S CLASSIFICATION
1. Type A
A1 fracture of the tubercle
A2 incomplete fractures of the waist

2. Type B
B1 Distal oblique fractures
B2 complete fracture of the waist
B3 proximal pole fracture
B4 fracture dislocations (associated with peri lunate dissociation)
3. Type C
Delayed union
4. Type D
Non-union

• IMAGING
Best view of the scaphoid PA view, wrist in ulnar deviation, beam tilted by 30*

TREATMENT

  • Scaphoid cast – BE cast with the forearm in the neutral position, wrist in 15-20* dorsiflexion, thumb in glass holding position with POP extending up to proximal phalanx leaving IP joint free
  • Serial X-rays have to be taken Between 6-12 weeks for assessment of the healing

A If the fracture is uniting/no displacement -continue cast/change into splint -apply for another 6 weeks

B If the fracture is displaced /or developed a cyst/or developed humpback deformity surgery is required

B1 Rigid fibrous non union
Compression screw fixation without additional bone graft

B2 Lax-crepitant displaced non union

Bone grafting and fixation
1 Matti technique/ cancellous bone, dorsal approach
2 Russe technique/cortico cancellous grafts, volar approach
3 Fisk-Fernandez /tri cortical wedge of iliac crest

SCREWS
1 Herbert’s screw[3.5-3.9 mm]
2 AO headless screw[2.4mm]
3 Accutrac screw

Screw placement -central position
1 ANTEGRADE /proximal to distal for waist and distal # proximal pole #
2 RETROGRADE/distal to proximal for #close to tuberosity

BONE GRAFTS
If avascularity develops vascularised bone grafts required
A PEDICLED

  • Zaidemberg 1.2 ICSRA Graft
  • Pronator Quadratus

B MICROVASCULAR

  • Free tissue transfer
  • Medial femoral condyle graft

SNAC Wrist

  • Scaphoid non union with advanced collapse
  • Degenerative changes of the wrist following un-united scaphoid fractures

SNAC Wrist stages and treatment

1 involves only radial styloid———styloidectomy
2 radio carpal involvement———-4 corner fusion, radiocarpal fusion, proximal row carpectomy
3 mid carpal involvement———–wrist fusion
4 global wrist involvement——-wrist fusion

Post Views: 3,765

Related Posts

  • Hand Fractures

    Courtesy: Dr Sudhir Warrier, Hand Surgeon, President, Bombay Orthopaedic Society

  • Percutaneous Fixation of Scaphoid fractures

    Courtesy: Gregory Yanish MD, FACS Capital Orthopaedic And Sports Medicine Clive, IOWA, USA

  • Scaphoid fractures and other Carpal Injuries

    Courtesy: Saqib Rehman MD Director of Orthopaedic Trauma Temple University Philadelphia Pennsylvania USA www.orthoclips.com

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Follow Us

instagram slideshare

Categories

  • -Applied Anatomy
  • -Approaches
  • -Basic Sciences
  • -Cartilage & Meniscus
  • -Classifications
  • -Examination
  • -Foot and Ankle
  • -Foot and Ankle Trauma
  • -FRCS(Tr and Orth) tutorials
  • -Gait
  • -Hand and Wrist
  • -Hand and Wrist Trauma
  • -Hand Infections
  • -Hip and Knee
  • -Hip Preservation
  • -Infections
  • -Joint Reconstruction
  • -Knee Arthroplasty
  • -Knee Preservation
  • -Metabolic Disorders
  • -Oncology
  • -OrthoBiologics
  • -OrthoPlastic
  • -Paediatric Orthopaedics
  • -Paediatric Trauma
  • -Patellofemoral Joint
  • -Pelvis
  • -Peripheral Nerves
  • -Principles
  • -Principles of Surgery
  • -Radiology
  • -Rheumatology
  • -Shoulder and Elbow
  • -Shoulder and Elbow Arthroplasty
  • -Spine Deformity
  • -Spine Oncology
  • -Spine Trauma
  • -Spine, Pelvis & Neurology
  • -Sports Ankle and Foot
  • -Sports Elbow
  • -Sports Knee
  • -Sports Medicine
  • -Sports Medicine Hip
  • -Sports Shoulder
  • -Sports Wrist
  • -Statistics
  • -Technical Tip
  • -Technology in Orth
  • -Trauma
  • -Trauma (Upper Limb)
  • -Trauma Life Support
  • -Trauma Reconstruction
  • Book Shelf
  • Book Shelf Medical
  • Careers
  • Case Studies and Free Papers
  • DNB Ortho
  • Evidence Based Orthopaedic Principles
  • Evidence Based Orthopaedics
  • Exam Corner
  • Fellowships
  • Guest Editor
  • Guest Reviews
  • Image Quiz
  • Instructional Course Lectures
  • Journal Club
  • MCQs
  • Meetings and Courses
  • Multimedia
  • News and Blog
  • Plaster Techniques
  • Podcasts
  • Public Health
  • Rehabilitation
  • Research
  • Shorts and Reels

Book Shelf

Kendall’s Muscle Testing and Function 6th Edition

Kendall’s Muscle Testing and Function 6th Edition

By admin Leave a Comment

Get Book Kendall’s Muscles: Testing and Function, with Posture and Pain, 6th Edition, transforms this landmark Physical Therapy classic to prepare you for unparalleled clinical success in today’s practice. Timeless coverage of manual muscle testing, evaluation, and treatment meets the latest evidence-based practices, engaging imagery, and dynamic digital resources to create a powerful resource you […]

Popular Posts

  • Bone Screws in Orthopaedic Surgery
  • Silverskold Test
  • Piriformis Syndrome
  • Blood Supply of Long Bone
  • Movements of the Thumb

Recent Comments

  • RAJATABHA BISWAS on NUH Fellowship in Singapore
  • Runj on ESSKA Congress 2026
  • OT Hand Therapist on Interosseous Muscles Of The Hand
  • Badreddine on Rockwood and Green Fractures in Adults and Children- 10th Edition
  • Prof Dr P.sridhar MS Ortho,D Ortho on Rockwood and Green Fractures in Adults and Children- 10th Edition

Exam Corner

FRCS Orth Exam- Knee Arthroplasty

Courtesy: Zaid al Rab, FOunder, OrthoPass

MCQ Exam for the FRCS Orth 1

Courtesy: Zaid al Rub, Founder, OrthoPass

Postgraduate Entrance Exam Set 3

Get explanatory answers from our book

Postgraduate Entrance Exam Set 2

Get explanatory answers from our book

Main Menu

  • Orthopaedic Principles
  • Editorial Board
  • Orthopaedic Principles-A Review

Recent Posts

  • Anterior Tibial Tendon Tears
  • Endoscopic Lumbar Microdiscectomy
  • RAMP Lesion of the Knee
  • Osteochondritis Dissecans of the Knee
  • Dual Mobility Cups in Total Hip Replacement

Links

  • Join Our Editorial Board
  • Journals
  • Weblinks
  • Submit Your Conference
  • Disclaimer
Copyright@orthopaedicprinciples.com. All right rerserved.