$scaphoid fracture surgery$

(Adapted from Raby N, Berman L, de Lacey G: Accident and emergency radiology. An abnormal scaphoid “fat stripe” or “stripe sign” may appear as an outward bulging radiolucent line in the soft tissue adjacent to the scaphoid, representing bleeding within the joint space, and may indicate the presence of an occult fracture.įigure 130-5 A, B, and C, Radiograph of the wrist demonstrating a scaphoid fracture-identified (with certainty) on one projection only. Conservative estimates suggest that 10% to 20% of scaphoid fractures are not visible on any view in the acute setting ( Figure 130-5). When any clinical suspicion for a scaphoid fracture is raised, obtain radiographs of the wrist that include a scaphoid view (a posteroanterior view in ulnar deviation). Another maneuver that suggests fracture of the scaphoid is pain in the snuff box with pronation of the wrist, followed by ulnar deviation (52% positive predictive value, 100% negative predictive value) ( Figure 130-4 ).įigure 130-3 The scaphoid compression test.įigure 130-4 Pronation of the wrist, followed by ulnar deviation.īe vigilant for associated injuries, such as fractures of the distal radius, lunate, or radial head at the elbow, scapholunate dissociation, or median nerve injury. Pain with the scaphoid compression test (applying a longitudinal axial load to the scaphoid via the proximal phalanx of the thumb through to the first metacarpal ) may also be helpful in identifying an underlying scaphoid fracture. Absence of tenderness with these two maneuvers makes a scaphoid fracture highly unlikely.įigure 130-2 Palpating the scaphoid tubercle while extending the wrist. Tenderness of the scaphoid tubercle (i.e., extend the patient’s wrist with one hand and apply pressure to the tuberosity at the proximal wrist crease with the opposite hand ) has a sensitivity of 87% but is more specific than snuff box tenderness (57%).

$scaphoid fracture surgery$

Other physical examination maneuvers should be performed. The classic hallmark of anatomic snuff box tenderness on examination is a highly sensitive (90%) indication of scaphoid fracture, but it is nonspecific (specificity, 40%). The pain, which may be mild, is worsened by gripping or squeezing.įigure 130-1 Examine for swelling or tenderness within the anatomic snuff box.įor comfort, apply a cold pack and a temporary splint or sling and administer any necessary analgesic.Ī thorough history and well-performed physical examination, along with a high index of suspicion, are necessary to make the diagnosis. Swelling may be seen, especially in the anatomic snuff box, the hollow seen on the radial aspect of the wrist when the thumb is in full extension (between the tendon of the extensor pollicis longus and the tendons of the abductor pollicis longus and extensor pollicis brevis) ( Figure 130-1). Physical examination discloses no deformity or ecchymosis but shows pain with motion and palpation and often swelling. The patient (usually 14 to 40 years of age) fell on an outstretched hand (FOOSH) with the wrist held rigid and extended and now complains of decreased range of motion and a deep full pain in the wrist, particularly on the dorsal radial side.

$scaphoid fracture surgery$

Scaphoid fracture surgery