Scaphoid fracture

Case contributed by A.Prof Frank Gaillard

Presentation

Fall of bicycle. Now tender left wrist.

Patient Data

Age: 35 years
Gender: Female
X-ray

A minimally displaced fracture through the waist of the scaphoid is demonstrated. The scapholunate interval appear perhaps minimally widened. The ulnar styloid demonstrates features of an old non-united fracture.  

There was concern of rotation of the scaphoid on lateral projection, and a CT was obtained. 

CT

Comminuted anteriorly impacted waist of scaphoid fracture producing a humpback deformity (seen on sagittal images).

Scapholunate relationship is maintained.  Mild widening of the scapholunate joint probably represents stretching, rather than disruption. Old ununited avulsion fractures of the ulnar styloid process. Small fleck of bone within the recess of the distal radioulnar joint.

X-ray

A headless cannulated dynamic compression screw transfixes left scaphoid. Site of the fracture remains visible, unchanged in alignment since the original examination. There has been some bony remodelling around the fracture site.

Annotated image
  • Figure 1: Waist of scaphoid fracture (blue arrow) appear minimally displaced on this view, and is associated with only marginal widening of the scapholunate interval (yellow arrow). 
  • Figure 2: Outline of the scaphoid on lateral projection (orange) is abnormal with an apparent humpback deformity (red arrow). 
  • Figure 3: CT confirms rotation of the proximal and distal poles, resulting in a humpback deformity (red). 
  • Figure 4: Dynamic cannulated compression screws work by having the thread wider apart at one end (orange) compared to the other end of the screw (yellow) In scaphoid fractures the screw is passed through the distal pole and then the proximal pole. As a result, the part engaged by the widely space thread (proximal pole) is moved along the screw a greater distance by each turn than the more distal pole; this has the net effect of compressing the fracture ends together. 

Case Discussion

This case illustrates a typical scaphoid fracture with operative management to correct for humpback deformity

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Case information

rID: 18269
Published: 24th Jun 2012
Last edited: 11th Sep 2018
Inclusion in quiz mode: Included

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