Scaphoid Fractures_UTSAV

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Scaphoid Fractures_UTSAV

  1. 1. Dr. UTSAV AGRAWAL
  2. 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. 3.  Boat or cashew shaped  80% of bone covered by articular surface expect tubercle  Located in a 45° plane to horizontal and vertical axes •
  4. 4.  Common in young adults  Fall on outstretched hand  Mechanism – Bending with compression dorsally and tension on palmar surface owing to forced dorsiflexion
  5. 5.  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
  6. 6. 80 % 15% 5% Time to union – 4-6 weeks Time to union – 10- 12 weeks Time to union – 12- 20 weeks
  7. 7. Type A Stable Acute fracture A1 : Fracture through tuberosity A2 : Incomplete fracture through waist HERBERT AND FISHER CLASSIFICATION
  8. 8. 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
  9. 9. Type C Delayed Union Type D Established Nonunuion Type D1: Fibrous Union Type D2: Pseudarthrosis
  10. 10. Type 1 – Tuberosity fracture Type 2 - Distal intra- articular fracture Type 3 – Osteochondral fracture
  11. 11.  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.
  12. 12. Percutaneous Herbert Screw Fixation
  13. 13.  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
  14. 14.  Type B3 - closed or open reduction and screw fixation through dorsal approach
  15. 15. VOLAR APPROACH
  16. 16.  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
  17. 17.  Patial radial styloidectomy and pronator quadratus bone graft
  18. 18. POST OP 10 weeks

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