🦴 Scaphoid Fractures

📊 Epidemiology

• Incidence in the UK: 12.4–29 per 100,000
• Most common in young males after fall on outstretched hand (FOOSH)

🧠 Anatomical Considerations

• Forms the floor of the anatomical snuffbox
• >80% of surface covered with articular cartilage, limiting vascular entry
• Blood supply enters distally → proximal fractures at high risk of avascular necrosis

⚠️ Mechanism of Injury

• Typical mechanism: FOOSH
• Fracture sites:
  • Tubercle
  • Distal pole
  • Waist (most common)
  • Proximal pole

📸 Diagnosis

Initial imaging:

• 4-view scaphoid series:
  • Posteroanterior (PA)
  • Pronated oblique
  • Ziter view (PA with ulnar deviation + 20° beam angle)
  • Lateral view
• Sensitivity in 1st week: ~80%

If initial X-ray is negative but suspicion remains:

• Immobilize in thumb spica
• Repeat imaging after 10 days
• MRI if diagnosis remains uncertain

🧩 Classification (by location)

• Tubercle
• Distal pole
• Waist (most frequent)
• Proximal pole

🩺 Management

• Undisplaced distal/tubercle/waist fractures: Conservative → Thumb spica cast for ~6 weeks
• Displaced waist fractures (>1–2 mm): Unstable → Surgical fixation required
• All proximal pole fractures: High risk of AVN → Surgical fixation recommended

⚠️ Complications

• Non-union
• Avascular necrosis (esp. proximal pole)
• Scapholunate ligament injury
• Wrist collapse
• Degenerative arthritis of radiocarpal joint