Scaphoid Fractures and Blood Supply

The scaphoid bone is the most commonly fractured carpal bone. Fractures of the scaphoid usually occur from a fall onto an outstretched hand. The patient will present with wrist pain and swelling. Scaphoid fractures may be negative on an x-ray and mistaken for a wrist sprain.

If a scaphoid fracture is suspected, the physician will want to look for tenderness in the anatomic snuffbox and immobilize the wrist adequately with a thumb spica for a short period of time. The physician should remove the case after 10 days, repeat the previously negative x-rays, and reexamine the patient.

Fracture types:

Waste Fracture
  1. Waste Fracture — The most frequent fracture site and has moderate risk of AVN and nonunion
Distal Pole Fracture

2. Distal Pole Fracture — AVN is rare

Proximal Pole Fracture

3. Proximal Pole Fracture — high incidence of nonunion and AVN

Tuberosity Fracture

4. Tuberosity Fracture

The blood supply of the scaphoid is unique and tenuous. Scaphoid fractures can lead to nonunion and avascular necrosis due to interruption of the blood supply.

Management for an acute scaphoid fracture begins with a reduction. Then, the fracture will be fixed with a compression screw. Fractures resulting in nonunion may be fibrous or sclerotic. Nonunion fractures will need to be reduced and fixed with a bone graft and compression screw.

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Dr. Ebraheim is the Chairman of Orthopaedics and the Director of the Orthopaedic Surgery Residency Program at the University of Toledo.

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Nabil Ebraheim

Nabil Ebraheim

Dr. Ebraheim is the Chairman of Orthopaedics and the Director of the Orthopaedic Surgery Residency Program at the University of Toledo.