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‡ Articular cartilage covers 80 % of the
scaphoid surface - only narrow area of its
neck, & even smaller distal portion, are
accessible to blood vessels
‡ Distally, it articulates with the trapezium and
trapezoid in a gliding motion, The articulation
with the trapezium forms a base for
independent movement of the thumb
‡ On the ulnar side, it articulates distally with
the capitate, and proximally with the lunate in
a rotary motion
‡ Proximally, its large, biconvex surface allows
] articulation with the radius
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‡ Major blood supply comes from the scaphoid


branches of the radial artery entering the
dorsal ridge at or just distal to waist area and
supplying 70-80 % of the bone including the
entire proximal pole - in a retrograde fashion
‡ Second group of vessels, arise from palmar &
superficial palmar branches of radial artery &
enter the distal tubercle, it perfuses distal 20-
30 % of bone, including tuberosity
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‡ There are no anastomoses between
the dorsal and palmar vessels
‡ Vessels enter thru dorsal ridge in 79 %,
distal to waist in 14 %, & proximal to
waist in 7 %
‡ Fractures across scaphoid may destroy
blood supply to its proximal part

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‡ Scaphoid flexes with wrist flexion &
extends with wrist extension
‡ It also flexes during radial deviation &
extends during ulnar deviation
‡ These factors make immobilization of
scaphoid fractures difficult especially
when there is displacement

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‡ Scaphoid is a principal bony block to
dorsiflexion of hand & wrist , and is
susceptible to frx during fall on outstretched
hand
‡ With scaphoid fx, distal scaphoid tends to
flex, & proximal scaphoid extends with the
proximal carpal row ,, because of this,
angulation occurs at fx site, which gradually
leads to a humpback deformity
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‡ Should demonstrate tenderness in the
anatomic snuff box
‡ Tenderness to palpation over scaphoid
tuberosity and/or proximal pole just distal
to Lister's tubercle
‡ Tenderness with axial compression of
thumb toward the snuff box
‡ Tenderness as patient supinates
forearm against resistance
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‡ Radial & ulnar deviation results in pain
on radial side of wrist
‡ Forced dorsiflexion usually elicits
significant tenderness
‡ There is usually pain at extremes of
motion
‡ Limitation of wrist motion : but not
dramatically
‡ |+Swelling : usually not present
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‡ It is the same DDx of radial sided wrist
pain
‡ Lunate dislocation or fx
‡ Sapholunate instability
‡ Radial styloid fx
‡ Trapezium fx
‡ Rupture of FCR tendon
‡ ECRB or ECRL avulsion

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A. Location of the fracture :
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D. Amount of fracture displacement
( stability ) :
‡ Undisplaced ---- stable
‡ Displaced ---- unstable

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‡ The unstable
fracture (displaced)
is defined as :
 
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U Öonoperative (    )--- there
have been three main areas of disagreement
in non-operative treatment of acute non
displaced fractures of scaphoid :
1- the position of the wrist in the cast
2- the need to include joints other than the
wrist in the cast
3- the duration of the immobilization


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‡ Consider changing the cast every 10-14
days for the first 6 weeks so that it
remains firm around forearm muscles
and the wrist
‡ Time to healing by location :
± Distal third fx heals in 6-8 weeks
± Middle third fx 8-12 weeks
± Proximal third fx 12-24 weeks
‡ A 95 % union rate can be expected with
this management
+
‡ Removal of the cast should not occur until
union has been documented on CT or
tomography
‡ Prognosis is excellent in undisplaced, stable
fractures if diagnosed and immobilized early
(95 % with x-ray evidence of beginning
consolidation at 6 weeks )

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‡ It is worthwhile to try electrical stimulation
(esp.when there is nonunion ), though there
is a lack of reliable double-blind study which
compares between series of patients treated
with immobilization alone and those treated
with immobilization and ES,


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± Primary internal fixation is treatment of
choice for unstable scaphoid frxs
± Fractures treated by primary internal
fixation, average time for return to work is
3.7 weeks with union rate 97 %

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‡ scapholunate advanced collapse
(SLAC) refers to a specific pattern of
osteoarthritis and subluxation which
results from untreated chronic
scapholunate dissociation or from
chronic scaphoid nonunion

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