Download - Scaphoid Fractures_UTSAV
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Dr. UTSAV AGRAWAL
SCAPHOID FRACTURES
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Derived from greek word ‘scaphos’ meaning boat
Boat or cashew shaped bone
Rule of 70 for scaphoid – Accounts for 70% of carpal fracturesOf these 70% occur at waist70% of scaphoid fractures unite70% of vascular supply is through dorsal
branch of radial artery
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Boat or cashew shaped80% of bone covered by articular surface
expect tubercleLocated in a 45° plane to horizontal and vertical axes•
ANATOMY
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Mechanism of Injury
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Common in young adultsFall on outstretched handMechanism – Bending with compression dorsally and tension on palmar surface owing to forced dorsiflexion
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Proper history about mechanism of injuryClinical examinationRadiographic evaluation – X-ray – PA view, lateral, Radial oblique, ulnar
oblique, Scaphoid view
MRI – 100% sensitivity even in 48 hrsTc 99 bone scans also have high sensitivity in
occult fractures
Diagnosis
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Gilula's Lines
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MRI
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CLASSIFICATION
80 %
15%
5%
Time to union – 4-6 weeks
Time to union – 10-12 weeks
Time to union – 12-20 weeks
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Type A Stable Acute fracture
A1 : Fracture through tuberosity
A2 : Incomplete fracture through waist
HERBERT AND FISHER CLASSIFICATION
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Type BUnstable Acute Fractures
Type B1: Distal Oblique Fracture
Type B2: Complete Fracture of Waist
Type B3: Proximal Pole Fracture
Type B4: Transscaphoid-Perilunate
Fracture-Dislocation of Carpus
Type B5: Comminuted Fractures
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Type C Delayed Union
Type DEstablished Nonunuion
Type D1: Fibrous Union
Type D2: Pseudarthrosis
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Russe Classification
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Prosser Classification
Type 1 – Tuberosity fracture
Type 2 - Distal intra-articular fracture
Type 3 – Osteochondral fracture
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Occult Fractures – Colles cast for 4-6 weeksType A1 – Colles cast cast for 4-6 weeksType A2 – Below elbow cast in neutral
position cast c ast for 6-12 weeks in low demand patients
in other patients percutaneous screw fixation
A displaced fracture is defined as one with more than 1 mm of step-off or more than 60 degrees of SL or 15 degrees of lunato-capitate angulation as observed on either plain radiographs or CT scans.
TREATMENT OPTIONS
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Percutaneous Herbert
ScrewFixation
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Type B2 – Percutaneous screw fixation - in case reduction cannot be achieved, open
reduction and internal fixation - Cast required in case of asso. ligamentous
injuryIn case of hump-back deformity, bone-grafting
may be required
Hump-back deformity
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Type B3 - closed or open reduction and screw fixation through dorsal approach
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Approach to scaphoid
VOLAR APPROACH
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Dorso-lateral approach
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Visualization of the joint capsule
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Ulnar deviate the hand to expose the scaphoid
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Scaphoid Non-union
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Type D1 – Open reduction and screw fixation with bone gafting- either from distal radius or iliac crest
Success – 60-95%Type D2 – Open reduction and internal
fixation with bone graft or vascularised bone graft – pronator quadratus
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Russ Graft
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Patial radial styloidectomy and pronator quadratus bone graft
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CASE REPORT
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POST OP
10 weeks
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THANK YOU