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9.23 Scaphoid (Carpal Navicular) Fracture


Presentation

The patient (usually 14-40 years old) fell on an outstretched hand, with the wrist held rigid and extended, and now complains of pain, swelling, and decreased range of motion in the wrist, particularly on the radial side. Physical examination discloses no deformity, but pain with motion and palpation and often swelling, especially in the anatomic snuff box (on the radial side of the wrist, between the tendon of the extensor pollicis longus and the tendons of the abductor pollicis longus and extensor pollicis brevis). A good sign is axial loading along the proximal phalanx of the thumb, eliciting pain at the base.

What to do:

Discussion

Because fractures of the scaphoid bone are common, because they are often invisible on x ray until weeks later, because the blood supply to the fractured area may be tenuous and non-union or avascular necrosis likely, and because the resultant pain and arthritis may severely limit hand function, it is prudent practice to splint or cast all potential scaphoid fractures with a thumb spica until orthopedic re-evaluation in 1-2 weeks.

References:


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD