Scaphoid Fracture

Diagnosis
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  • Scaphoid fractures account for up to 85% of carpal fractures, most commonly from a fall on an outstretched hand 
  • Scaphoid fractures occur in the proximal, middle (“waist”, most common), and distal poles
  • There is a single intraosseous artery to the scaphoid, which enters at the waist and supplies the proximal pole in a retrograde fashion
  • Most scaphoid fractures heal with casting alone 
  • Osteonecrosis most commonly occurs in proximal pole and displaced fractures
  • Surgery is performed for proximal pole, unstable/displaced fractures, or nonunion/osteonecrosis
  • Routine wrist MRI sequences include Sagittal PD, axial T2 Fat-Sat (FS), coronal T1 and T2 FS, axial and coronal GRECarpal fractures exhibit linear T1 hypointensity with surrounding edema (T2-hyperintensity) 
  • A scaphoid fracture segment with hypointense T1- and T2-signal is suspicious for osteonecrosis/nonunion; with osteonecrosis, the scaphoid will exhibit fragmentation and collapse
  • Short protocol MRI exams (STIR and T1) have high negative predictive values, negating unnecessary immobilization and follow-up radiation
  • Non-union predisposes to scaphoid non-union advanced collapse (SNAC) with the proximal scaphoid fragment usually remaining attached to the lunate and the distal fragment rotating into flexion, resulting in early osteoarthritis between the radial styloid and the distal scaphoid fragment
  1. Khalid M, Jummani ZR, Kanagaraj K et-al. Role of MRI in the diagnosis of clinically suspected scaphoid fracture: analysis of 611 consecutive cases and literature review. Emerg Med J 2010; 27(4):266
  2. Memarsadeghi M, Breitenseher MJ, Schaefer-prokop C et-al. Occult scaphoid fractures: comparison of multidetector CT and MR imaging–initial experience. Radiology 2006; 240(1):169-7
  3. Von Borstel D, Horiuchi S, Strle N, Yoshioka H. MRI of the wrist. J Am Osteopath Coll Radiol 2018; 7(3):15-27

Related Cases

Cases

14-year-old male who fell on outstretched hand now has radial sided pain

MSK, Wrist,