Scaphoid fracture

Scaphoid fracture by Dr Bipul Borthakur

1. SCAPHOID DR . ANSHUMAN DUTTA ASSOCIATE PROFESSOR, DEPT OF ORTHOPAEDICS,SMCH

2. INTRODUCTION-Anatomy

3. INTRODUCTION-Anatomy Dorsal aspect Palmar aspect

4. SCAPHOID BLOOD SUPPLY Arises from the dorsal distal pole Means proximal pole has poor blood supply Proximal pole is less likely –to heal than distal pole

5. SCAPHOID FRACTURE It accounts for almost 75% of all carpal fractures Rare in elderly and children

6. SCAPHOID FRACTURE PATHOANATOMY:- -Lies obliquely across 2 rows of carpal bones -Also in the line of loading between the thumb and forearm MECHANISM OF INJURY :- Fall on outstretched hand

7. SCAPHOID FRACTURE Fracture occurs in 3 anatomical sites 1.Distal tubercle 2.Waist 3.Proximal pole Distal oblique and waist fractures are - unstable, hence predisposes to non-union or malunion

8. SCAPHOID FRACTURE CLINICAL FEATURES:- - May be deceptively normal -Usually detect fullness in the anatomical snuffbox -Look for Pain on axial compression and on ulnar distraction Tenderness over the tubercle and snuffbox

9. SCAPHOID FRACTURE X-RAY: AP and lateral view of the wrist joint Oblique view of the wrist joint is usually helpful MRI: To detect the avascular necrosis of scaphoid in neglected fractures

10. SCAPHOID FRACTURE ACUTE FRACTURES :- Usually fracture line is transverse and through the narrowest part of the bone ( Waist) If fracture is more proximally situated (Proximal pole fracture) Sometimes only the tubercle of scaphoid is fractured

11. SCAPHOID FRACTURE-Acute fractures Contd.. Look for signs of displacement or instability; - Obliquity of the fracture line - Angulation of the distal fragment and foreshortening

12. SCAPHOID FRACTURE DELAYED UNION AND NON UNION:- If union is delayed, fracture line becomes more apparent and hard border develops—May look like an extra carpal bone As non-union establishes , cavitation appears on either side of break.

13. SCAPHOID FRACTURE TREATMENT FRACTURE OF THE TUBERCLE :- Are treated in a cast for 4-6 weeks Usually there are no complications , but occasionally there is non union needing excision of smaller fragment or grafting of larger fragment.

14. SCAPHOID FRACTURE TREATMENT UNDISPLACED WAIST FRACTURES:- 1. BY PLASTER :- - 90% waist fractures heals in a plaster - A neutral forearm cast from the upper forearm to just short of the MCP joints of fingers, the thumb not incorporated. If cast fails:- Bone grafting and Internal fixation is done

15. SCAPHOID FRACTURE SCAPHOID CAST

16. SCAPHOID FRACTURE TREATMENT 2. BY PERCUTANEOUS FIXATION :- Practiced in patents requiring speedy recovery

17. SCAPHOID FRACTURE TREATMENT DISPLACED FRACTURES :- Can also be treated in plaster It may or may not heal in a poor position It’s better to reduce the fracture(closed>open) and fix it with a compression screw

18. SCAPHOID FRACTURE TREATMENT PROXIMAL POLE FRACTURES :- It may heal in a plaster. But needs prolonged duration. Risk of non-union is high and disadvantages of prolonged immobilization are high, So consider surgical fixation

19. SCAPHOID FRACTURE COMPLICATIONS AVASCULAR NECROSIS :- Proximal fragment may die especially with small proximal pole fractures , which are further from their blood supply. TREATMENT:- For small proximal pole fragments, bones can be stabilized by a very small screw . If space present, a bone graft from distal radius is inserted

20. SCAPHOID FRACTURE AVASCULAR NECROSIS

21. SCAPHOID FRACTURE COMPLICATIONS NON-UNION :- In acute stages , surgery(Grafting ) is advised to reduce the chance of symptomatic arthritis. OSTEOARTHRITIS :- Non-union and Avascular necrosis leads to secondary osteoarthritis

22. BENNETT’S FRACTURE - DISLOCATION Fracture at the base of the thumb Oblique fracture line extending up to CMC joint Falling or punching Pull of APL tendon makes it very unstable

23. BENNETT’S FRACTURE - DISLOCATION X-ray AP and oblique view of hand Treatment: perfect fracture reduction Conservative with plaster Operative with K-wire or screw fixation

24. ROLANDO’S FRACTURE Intra-articular comminuted fracture at the base of the thumb “T” or “Y” fracture line, highly unstable fracture Falling or punching

25. ROLANDO’S FRACTURE X-ray AP and oblique view of hand Treatment: perfect fracture reduction Always operative with K-wire or plate fixation External fixator for severely comminuted fracture

26. THANK YOU