Scaphoid fracture (summary)
Citation, DOI & article data
This is a basic article for medical students and other non-radiologists
Scaphoid fractures are the second commonest group of fractures that are seen following a fall onto an outstretched hand and result in wrist pain, specifically tenderness in the anatomical snuffbox. They are particularly important because of the risk of avascular necrosis if displaced fractures aren't treated appropriately.
- can occur at any age
- commonest in male adolescents and young adults (10-19) 1
- wrist pain following a fall onto an outstretched hand
- focal tenderness over the anatomical snuffbox
- commonest carpal bone fracture
- scaphoid fractures may be occult on plain radiographs
- a scaphoid series (4 views) more sensitive than wrist x-ray (2 views)
- if normal with continued symptoms, further imaging can be performed
- non-displaced fractures treated with immobilization in cast
- internal fixation may be required for displaced waist fractures
- most fractures heal without complications
- non-union may occur
- avascular necrosis can occur and result in chronic pain
Plain radiographs (4-view scaphoid series) is used for diagnosis. However, scaphoid fractures may be occult and the risk of avascular necrosis merits follow-up in patients with continued symptoms.
Additional follow-up in this group can make use of a bone scan or MRI because of their greater sensitivity and specificity.
- scaphoid series (4 views)
A lucent line across the waist of the scaphoid is the commonest site for fracture. However, displaced and non-displaced fractures of the proximal and distal pole may be seen.
An MRI is a very sensitive test for looking at bone edema which occurs after fracture. There will be increased signal in edematous bone marrow on the fluid-weighted sequences (T2/STIR) and reduced signal on T1. It is also very sensitive for a ligamentous injury.
Where MRI is not available, a bone scan may be useful. There will be increased tracer uptake in the scaphoid following fracture.