Once the scaphoid fracture is diagnosed, the physician has to consider three factors: fracture location, displacement and associated injuries. In general, if I simply want to prove that a suspected scaphoid fracture exists, I will order a CT scan, whereas if I am concerned that there is a serious wrist injury with nonspecific clinical findings, I will order an MRI. MRI is better for identifying concomitant ligamentous injuries and altered scaphoid vascularity, but may be overly sensitive in diagnosing scaphoid contusions as fractures. CT is better for assessing scaphoid fracture displacement, but is not quite as sensitive in detecting non-displaced fractures. Computed tomography (CT) and magnetic resonance imaging (MRI) are both reasonable next steps. For the elite athlete, time is of the essence in making a definitive diagnosis. Occasionally, resorption at the fracture site will make the scaphoid fracture evident. He can choose to immobilise the wrist for 2 weeks, and then repeat the clinical examination and radiographs. If the initial radiographs are normal in a clinically-suspected scaphoid fracture, the physician has several options. In about 16% of such cases, the fracture will eventually become apparent. Therefore, the physician should immobilise any injured wrist whenever a scaphoid fracture is suspected, regardless of whether the radiographs are normal. These fractures are notoriously difficult to treat, and failure to initiate cast immobilisation within 4 weeks is an independent risk factor for non-union. The latter two views are intended to horizontalise the flexed scaphoid, placing the fracture plane in line with the X-ray beam. The diagnosis is confirmed with radiographs, including a posterior-to-anterior (PA) and lateral of the wrist, a PA in ulnar deviation and a semi-pronated PA view. The most specific clinical finding is ‘snuffbox’ tenderness, found by palpating the wrist in the hollow between the abductor pollicis longus and the extensor pollicis longus. Often the athlete will ignore the injury, assuming that it was a sprain. Scaphoid fractures may result in a minimal degree of swelling. Among female athletes sustaining scaphoid fractures, rollerblading and skateboarding were the most common activities. Among male athletes, the highest number of scaphoid fractures occurred while playing basketball (11%) followed by bicycling and skateboarding. The peak age range was 10 to 19, followed closely by 20 to 29 years of age. Using United States National Emergency Department data, a 2010 study demonstrated that two-thirds of scaphoid fractures occurred in men. Another reported mechanism for scaphoid fracture is contact with a closed fist, termed ‘puncher’s fracture’. The advent of percutaneous scaphoid fixation offers the possibility of earlier return to sport, but is it worthwhile? This paper will review contemporary issues regarding the fractured scaphoid.įar and away, the most common mechanism of injury is fall onto an outstretched hand. Even in the best of circumstances, cast treatment will likely keep the athlete on the sidelines for several months. The diagnosis is easily missed, and failure to initiate treatment promptly may result in non-union. Not many upper extremity injuries are as potentially devastating to the athlete as scaphoid fractures. Should we be repairing all scaphoid fractures in the athlete?
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