4. Primary Survey
• A : Patent airway, no c-spine tenderness
• B : Trachea in midline, equal BS both lungs
• C : BP 148/69 Pulse 60/min RR18/min BT36.4 c
• D : E4M6V5 , pupils 3 mmRTLBE
• E : Marked tender at Rt.wrist laterally, mild
swelling, limit ROM, no external wound
5. Physical Examination
• GA : A Thai man, alert, well-cooperative
• HEENT : Not pale, anicteric sclera
• Heart : Normal S1S2, no murmur
• Lungs : Clear both lungs
• Abdomen : Soft, not tender
• Extremities: Tender at Rt. snuffbox, tender with thumb axial
loading, tender at Rt. scaphoid tubercle, mild
swelling, with limit ROM, Radial pulse 2+,
sensory -intact
• Other : Unremarkable
12. Scaphoid Bone
• Scaphoid is most frequently fractured carpal
bone.
• Epidemiology
– Incidence : up to 15% of acute wrist injuries
– Location : waist -65%, proximal third - 25%,
distal third - 10%
13. Anatomy
• Articular surface> 75% of scaphoid bone is covered by
articular cartilage
• Blood supply - major blood supply is dorsal carpal branch
(80%)
• Motion - with wrist flexion and radial deviation and it
extends during wrist extension and ulnar deviation
14. Pathoanatomy
• most common mechanism of injury
– axial load across hyper-
extended and radially deviated wrist (common in
contact sports)
16. Imaging
• Radiographs
– AP and lateral , scaphoid view
• Bone scan
– effective to diagnose occult fractures at 72 hours
17. Imaging
• MRI
– most sensitive for diagnosis occult fractures < 24
hours
– identification of fractures / ligamentous injuries
– assessment of vascular status of bone
• CT scan with 1mm cuts
18. Treatment
• Non-operative
– thumb spica cast immobilization
• Indications
– stable nondisplaced fracture (majority of fractures)
– normal xrays but there is a high level of suspicion
• Duration - depends on location of fracture
– 8-12 weeks
• Operative
– unstable fractures
• proximal pole fractures
• displacement > 1 mm
• Outcomes
– union rates of 90-95% with operative treatment of scaphoid
fractures
