Scaphoid Fractures
The scaphoid is the most commonly fractured carpal bone. Remember, if a fracture is suspected (tenderness to the anatomic snuffbox) but not seen on x-ray, the patient still needs to be sent home in a thumb spica splint. Here's a quick summary.
• Most common carpal bone fracture
• Complications
• Avascular necrosis: most commonly affects proximal portion as a result of arterial supply to the scaphoid entering distally
• Nonunion or malunion: associated with missed fractures that are inadequately immobilized
• Both lead to carpal instability and osteoarthritis
• Mechanism: Fall onto outstretched hand
• Exam: Tenderness to anatomic snuffbox, pain with supination
• Possible associated injuries: Scapholunate dissociation, perilunate dislocation
• ED Management: Pain control, immobilize
• Splint: Thumb spica
• Ortho consult: No (unless displaced mm, proximal pole fracture, associated scapholunate dissociation)
• Disposition: Discharge — if known fracture, follow-up with Orthopedics within 1 week; if suspected fracture, follow-up with PCP or orthopedics in 2 weeks for repeat x-rays
MH/CCF/CWRU EM Res @MetroHealth_EM
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