Scaphoid fracture

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scaphoid fracture in short..taught by my sir

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Scaphoid fracture

  1. 1. S C A P H O I D F R A C T U R EG O P I S A N K A R . M . GCase discussion
  2. 2. Scaphoid A commonly fractured bone Most common congenitally absent bone Visible and palpable part is tuberosity of scaphoid inanterior aspect of wrist It is more visible dorsiflexion and radial deviation ofwrist why because scaphoid undergoes flexion at thisposition
  3. 3.  Disappears on flexion and ulnar deviation as itextends
  4. 4.  The above reasons explain why falling on outstrectched hand produces this fracture As when we fall--- keeps the wrist in dorsiflexionand radial deviation Actually it also depends on (that is fracture) anglebetween the forearm and wrist When that angle is around 90 degree we fall on thetuberosity directly
  5. 5.  If angle is at 60 degree u get???? Distal fracture colles fracture If angle less than that ie less than 60 degree u mayget forearm bones fracture radius or ulna Thus mechanism of injury is very important
  6. 6.  Scaphoid means “boat shaped” 70 percent of the bone is covered by articularcartilage Rest by bone
  7. 7.  Blood supply is via radial artery Two grops volar and dorsal Volar supplies the scaphoid tubercle Dorsal  supply is from distal to proximal soproximal pole is not getting direct blood supply So in fracture it can undergo AVN (avascularnecrosis)
  8. 8. Parts of scaphoid Proximal pole(AVN chance) Waist (most common site of fracture) Distal pole Tuberosity
  9. 9. Diagnosis clinical often missed suspect when falls on out stretched hands
  10. 10. Signs1. Tenderness in the anatonical snuff box As floor of the snuff box is formed by the scaphoidand trapezius bone
  11. 11.  2. Axial compression on the thumb produces pain 3. Pronate against resistance causes pain
  12. 12. Xray AP,Lat ,Oblique View in ulnar deviation an undisplaced fracture canbe found but Xrays may be negative for first two weeks Other options  isotope bone scan Tc 99 MRI 3D CT scan
  13. 13. Management Undisplaced plaster Scaphoid cast  glass holding position extends uptodistal transverse crease in other fingers On thumb upto base of P2 Casts for a minimum of 6 weeks Take xray
  14. 14. If displaced Better to cannulate the bone unde C arm guidance Or can do open reduction Implant is Herbert’s screw it is a cannulated screwand a handleless screw With differential pitch that is thread size on one endis not similar to another
  15. 15.  We put it from distal to proximal Distal is bigger thatn proxiamal After Herebert’s screw  3 months immobilisation
  16. 16. When will u call as nonunion After 4 months if not united More with conservatuve management In displaced fracture
  17. 17. xray Proximal fragment sclerosis Can excise it if it is less than 20% of total area ofscaphoid If big can do bone grafting Vascularised graft
  18. 18. Graft options1. Take a free vascularised bone graft ---take a bonegraft with blood supply and anastomosis2. Take a piece of bone with muscle and intact BS---pronator quadratus and radius and put intoscaphoid
  19. 19.  If neglected SNAC  Scaphoid Nonunion Asdvanced Collpase Secondary osteoarthritis Finally may have to wristy arthrodesis at 30 degreeflexion
  20. 20. Thanku

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