Scaphoid Fractures



 

Scaphoid fracture more clear on Scaphoid view. 


Scaphoid view is taken with Hand and wrist on ulnar deviation along with 15 degrees of cephalad angulation of x-ray tube. 


Indications of Internal Fixation of Scaphoid fractures

    1. Displacement > 1 mm

   2. SL angle > 60 degrees

   3. Lunocapitate angle > 15 degrees

   4.Intrascaphoid angle > 20 degrees (dorsal humpback )

   5. Proximal pole fractures, fractures associated with a perilunate           dislocation 

    6. Delayed union


Should acute non-displaced fractures be fixed ? 

Chances of non-union is 10 %. 

Rate of delayed union lesser with early fixation. 

Early outcome scores are better in terms of grip strength, ROM but no difference after 12-16 weeks.


Complications of scaphoid fractures 

    1.AVN of proximal pole 

    2.Non union 


Management of established non union of Scaphoid Bone

No arthritic changes 

    Fixation with bone grafts

    Distal radius bone graft based on 1,2 intermetacarpal branch of             radial artery (success rate - 70 percent )


 Arthritic changes present 

    - Radial Styloidectomy

    - Proximal row carpectomy

    - Scaphoid Excision 

    - Four corner fusion 

    - Wrist arthrodesis





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