70% of carpal fracture
Unseen in 30% of X ray upon injury -> Treat First!
Hyperextension, axial compression (“FOOSH” injury )
Anatomic snuffbox Scaphoid tubercle tenderness
Axial compression of the thumb pain
Distal, middle(waist), proximal type by location
Distal wrist volar prominance, Snuff box swelling, pain
Hyperextension, axial compression – 손짚는 자세
Worse prognosis for proximal: artery supplied from distal
– distal부터 a. supply되므로 proximal로 갈수록 예후 안 좋음>> Op indication
Physical exam
Anatomic snuffbox td
Scaphoid tubercle td
Axial compression of the thumb
Stability
Displacement > 1mm
Angulation > 15 degrees
Proximal
UNSTABLE
Treatment
Stable fracture -> Immobilization
Thumb spica cast
Unstable fracture -> operation
E.g. displaced and proximal pole, co-exist with other fractures or dislocation
Internal or external fixation
ED management: DDx, immobilization
thumb spica cast immobilization
ORIF vs percutaneous screw fixation
unstable fractures
proximal pole fractures
displacement > 1 mm
15° scaphoid humpback deformity
radiolunate angle > 15° (DISI)
intrascaphoid angle of > 35°
scaphoid fractures associated with perilunate dislocation
comminuted fractures
unstable vertical or oblique fractures
in non-displaced waist fractures
to allow decreased time to union, faster return to work/sport, similar total costs compared to casting
