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Scaphoid fracture

Wirt MDW - MedPix (2001)

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Affiliation: Tripler Army Medical Center

ABSTRACT

History: 22-year-old male with persistent right wrist “snuff-box” pain for two months. The patient is status-post fall on his outstretched hand in December 2000. Initial plain film images of the wrist were interpreted as normal. Radiological Findings: A follow-up plain film study of the right wrist one month after injury demonstrates no evidence of scaphoid fracture, Figure 1. A Tc-99m-MDP bone scan of the wrists and hands demonstrates intense focal uptake in the region of the right scaphoid bone, Figure 2. Diagnosis: Occult non-displaced fracture of the right scaphoid bone. Differential Diagnosis: Fracture vs. avascular necrosis of the right scaphoid. Discussion: Scaphoid fractures may not been seen on plain radiographs until 10-21 days post injury (1). Since the blood supply to the scaphoid is from distal to proximal, nonunion and avascular necrosis are common outcomes with undetected scaphoid fractures (1). There are four primary fracture zones: 1) The scaphoid neck; 2) The waist; 3) The body; 4) The proximal pole. (2). Most fractures involve the waist. When they are non-displaced, with no carpal instability, >90% heal with non-operative treatment (1). Continued snuff-box tenderness suggests an occult fracture in the presence of a normal plain radiograph. A Tc99m-MDP bone scan may be considered as the next imaging step, where intense focal uptake is suggestive of an occult fracture vs. avascular necrosis. The bone scan may be followed by a CT or MRI of the wrist to confirm the fracture and plan treatment options. Treatment: Prolonged immobilization (8-12 weeks) in casting material is required for non-operative treatment of non-displaced fractures. Displaced scaphoid fractures require Open Reduction Internal Fixation (ORIF) and bone grafting (1).

No MeSH data available.


Figure 1.  An A/P View if the right wrist demonstrates no evidence of scaphoid fracture.
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MPX2663_synpic959: Figure 1. An A/P View if the right wrist demonstrates no evidence of scaphoid fracture.


Scaphoid fracture

Wirt MDW - MedPix (2001)

Figure 1.  An A/P View if the right wrist demonstrates no evidence of scaphoid fracture.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2663&req=5

MPX2663_synpic959: Figure 1. An A/P View if the right wrist demonstrates no evidence of scaphoid fracture.

View Article: MedPix Image - MedPix Topic

Affiliation: Tripler Army Medical Center

ABSTRACT

History: 22-year-old male with persistent right wrist “snuff-box” pain for two months. The patient is status-post fall on his outstretched hand in December 2000. Initial plain film images of the wrist were interpreted as normal. Radiological Findings: A follow-up plain film study of the right wrist one month after injury demonstrates no evidence of scaphoid fracture, Figure 1. A Tc-99m-MDP bone scan of the wrists and hands demonstrates intense focal uptake in the region of the right scaphoid bone, Figure 2. Diagnosis: Occult non-displaced fracture of the right scaphoid bone. Differential Diagnosis: Fracture vs. avascular necrosis of the right scaphoid. Discussion: Scaphoid fractures may not been seen on plain radiographs until 10-21 days post injury (1). Since the blood supply to the scaphoid is from distal to proximal, nonunion and avascular necrosis are common outcomes with undetected scaphoid fractures (1). There are four primary fracture zones: 1) The scaphoid neck; 2) The waist; 3) The body; 4) The proximal pole. (2). Most fractures involve the waist. When they are non-displaced, with no carpal instability, >90% heal with non-operative treatment (1). Continued snuff-box tenderness suggests an occult fracture in the presence of a normal plain radiograph. A Tc99m-MDP bone scan may be considered as the next imaging step, where intense focal uptake is suggestive of an occult fracture vs. avascular necrosis. The bone scan may be followed by a CT or MRI of the wrist to confirm the fracture and plan treatment options. Treatment: Prolonged immobilization (8-12 weeks) in casting material is required for non-operative treatment of non-displaced fractures. Displaced scaphoid fractures require Open Reduction Internal Fixation (ORIF) and bone grafting (1).

No MeSH data available.