Scaphoid fracture

Mechanism

• Typically fall onto outstretched hand with hyperextended wrist

Clinical features

• Anatomical snuffbox tenderness
• Pain on 'telescoping' thumb
• Scaphoid tubercle tenderness on palmar surface

Key Points

• May not be visible on X-ray initially.
• 2015 NICE guidance advocates MRI as 1st line imaging investigation due to the high rate of missed fractures on both X-ray & CT. Most emergency departments in the UK do not have sufficient access to MR scanning to facilitate this.

- Previous guidance advised that if clinical features consistent with fracture appropriate to immobilise and re X-ray in 2 weeks when bone resorption should make fracture line visible. This may still be utilised in centres where MRI scanning is not readily available but now more common for suspected fractures with negative x-ray to be immobilised and followed up in fracture clinic with a view to perform MRI

• High rate of AVN due to retrograde blood supply from dorsal carpal branch of radial artery.

Management

• Undisplaced fractures can be immobilised with thumb spica cast
• ORIF or screw fixation frequently required