This document discusses the anatomy, classification, clinical presentation, diagnosis, and treatment of scaphoid fractures. Some key points: - The scaphoid bone has a boat or cashew shape and accounts for 70% of carpal fractures. - Scaphoid fractures are commonly caused by a fall on an outstretched hand and result from forced dorsiflexion. - Diagnosis involves history, clinical exam, and imaging like X-rays, MRI, or bone scans. - Fractures are classified by the Herbert and Fisher system into stable or unstable acute fractures, delayed unions, and nonunions. - Treatment depends on the type but may include casting

1. Dr. UTSAV AGRAWAL

2.  Derived from greek word ‘scaphos’ meaning boat
 Boat or cashew shaped bone
 Rule of 70 for scaphoid –
 Accounts for 70% of carpal fractures
 Of these 70% occur at waist
 70% of scaphoid fractures unite
 70% of vascular supply is through dorsal branch of
radial artery

3.  Boat or cashew shaped
 80% of bone covered by articular surface expect
tubercle
 Located in a 45° plane to horizontal
and vertical axes
•

8.  Common in young adults
 Fall on outstretched hand
 Mechanism – Bending with
compression dorsally and tension
on palmar surface owing to forced
dorsiflexion

9.  Proper history about mechanism of injury
 Clinical examination
 Radiographic evaluation –
 X-ray – PA view, lateral, Radial oblique, ulnar
oblique, Scaphoid view
 MRI – 100% sensitivity even in 48 hrs
 Tc 99 bone scans also have high sensitivity in occult
fractures

13. 80 %
15%
5%
Time to union – 4-6
weeks
Time to union – 10-
12 weeks
Time to union – 12-
20 weeks

14. Type A
Stable Acute fracture
A1 : Fracture through tuberosity
A2 : Incomplete fracture through waist
HERBERT AND FISHER
CLASSIFICATION

15. Type B
Unstable 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

16. Type C Delayed Union
Type D
Established Nonunuion
Type D1: Fibrous Union
Type D2: Pseudarthrosis

18. Type 1 – Tuberosity
fracture
Type 2 - Distal intra-
articular fracture
Type 3 –
Osteochondral
fracture

19.  Occult Fractures – Colles cast for 4-6 weeks
 Type A1 – Colles cast cast for 4-6 weeks
 Type 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.

20. Percutaneous
Herbert
Screw
Fixation

21.  Type B2 – Percutaneous screw fixation
- in case reduction cannot be achieved, open
reduction and internal fixation
- Cast required in case of asso. ligamentous injury
In case of hump-back deformity, bone-grafting may be
required
Hump-back deformity

22.  Type B3 - closed or open reduction and screw fixation
through dorsal approach

23. VOLAR APPROACH

31.  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

33.  Patial radial
styloidectomy and
pronator quadratus
bone graft

35. POST OP
10 weeks