scaphoid fractures_utsav
TRANSCRIPT
Dr. UTSAV AGRAWAL
SCAPHOID FRACTURES
Derived from greek word ‘scaphos’ meaning boat
Boat or cashew shaped bone
Rule of 70 for scaphoid – Accounts for 70% of carpal fracturesOf these 70% occur at waist70% of scaphoid fractures unite70% of vascular supply is through dorsal
branch of radial artery
Boat or cashew shaped80% of bone covered by articular surface
expect tubercleLocated in a 45° plane to horizontal and vertical axes•
ANATOMY
Mechanism of Injury
Common in young adultsFall on outstretched handMechanism – Bending with compression dorsally and tension on palmar surface owing to forced dorsiflexion
Proper history about mechanism of injuryClinical examinationRadiographic evaluation – X-ray – PA view, lateral, Radial oblique, ulnar
oblique, Scaphoid view
MRI – 100% sensitivity even in 48 hrsTc 99 bone scans also have high sensitivity in
occult fractures
Diagnosis
Gilula's Lines
MRI
CLASSIFICATION
80 %
15%
5%
Time to union – 4-6 weeks
Time to union – 10-12 weeks
Time to union – 12-20 weeks
Type A Stable Acute fracture
A1 : Fracture through tuberosity
A2 : Incomplete fracture through waist
HERBERT AND FISHER CLASSIFICATION
Type BUnstable Acute Fractures
Type B1: Distal Oblique Fracture
Type B2: Complete Fracture of Waist
Type B3: Proximal Pole Fracture
Type B4: Transscaphoid-Perilunate
Fracture-Dislocation of Carpus
Type B5: Comminuted Fractures
Type C Delayed Union
Type DEstablished Nonunuion
Type D1: Fibrous Union
Type D2: Pseudarthrosis
Russe Classification
Prosser Classification
Type 1 – Tuberosity fracture
Type 2 - Distal intra-articular fracture
Type 3 – Osteochondral fracture
Occult Fractures – Colles cast for 4-6 weeksType A1 – Colles cast cast for 4-6 weeksType A2 – Below elbow cast in neutral
position cast c ast for 6-12 weeks in low demand patients
in other patients percutaneous screw fixation
A displaced fracture is defined as one with more than 1 mm of step-off or more than 60 degrees of SL or 15 degrees of lunato-capitate angulation as observed on either plain radiographs or CT scans.
TREATMENT OPTIONS
Percutaneous Herbert
ScrewFixation
Type B2 – Percutaneous screw fixation - in case reduction cannot be achieved, open
reduction and internal fixation - Cast required in case of asso. ligamentous
injuryIn case of hump-back deformity, bone-grafting
may be required
Hump-back deformity
Type B3 - closed or open reduction and screw fixation through dorsal approach
Approach to scaphoid
VOLAR APPROACH
Dorso-lateral approach
Visualization of the joint capsule
Ulnar deviate the hand to expose the scaphoid
Scaphoid Non-union
Type D1 – Open reduction and screw fixation with bone gafting- either from distal radius or iliac crest
Success – 60-95%Type D2 – Open reduction and internal
fixation with bone graft or vascularised bone graft – pronator quadratus
Russ Graft
Patial radial styloidectomy and pronator quadratus bone graft
CASE REPORT
POST OP
10 weeks
THANK YOU