Wrist
Scaphoid Fracture
주상골 골절
Scaphoid fracture causing radial wrist pain — initial X-ray may be negative, risk of avascular necrosis
- How common
- Uncommon
- Typical age
- Ages 15–40
What is it?
FOOSH (Fall On OutStretched Hand) hyperextension impact fractures scaphoid — blood supply flows distal to proximal, creating AVN risk with proximal fractures
Commonly affected: Scaphoid bone, primary blood supply: dorsal branch of radial artery
How it develops
- FOOSH MechanismWrist hyperextension during fall — scaphoid fractured between radius and trapezium
- Vascular VulnerabilityScaphoid blood supply flows distal to proximal → waist/proximal fractures cut off blood to proximal fragment
- Initial X-ray NegativeFracture line may not be visible on X-ray (15-20% false negative) → CT or MRI needed
- AVN and Nonunion RiskUntreated or proximal pole fractures risk AVN and nonunion → scaphoid nonunion advanced collapse (SNAC)
Symptoms
- Anatomical Snuffbox TendernessTenderness in anatomical snuffbox (between EPL and APL-EPB tendons) — most important sign
- Thumb Axial Compression PainPain with axial compression of thumb directed toward scaphoid
- Radial Wrist SwellingMild radial wrist swelling — persists even with normal X-ray
- Grip WeaknessGrip and grasping function reduced due to pain
How it is examined
- Anatomical Snuffbox TendernessTenderness in snuffbox (between 1st-2nd extensor compartments) → most sensitive sign for scaphoid fracture
- Scaphoid Tubercle TendernessDirect tenderness over scaphoid tubercle (volar radial wrist prominence)
- Thumb Axial CompressionPain at wrist with axial thumb compression → suspect scaphoid fracture
Imaging
Initial 20% false negative. Clinical suspicion requires further imaging even with normal X-ray
- Initially normal (15-20%)
- Scaphoid waist fracture line (PA/lateral/oblique views)
- Scaphoid fat pad sign
- Repeat at 2 weeks may show fracture line due to bone resorption
Gold standard for scaphoid fracture — can confirm fracture within 24-48 hours of injury
- T1 low-T2 high signal fracture line
- Bone marrow edema (T2 STIR hyperintense)
- Proximal fragment T1 low signal → suspect AVN
- Nonunion signs
Non-surgical care
- Thumb Spica CastDistal fractures: 6-8 weeks short arm thumb spica cast
- Long Arm Thumb Spica CastWaist/proximal fractures: 8-12 weeks long arm thumb spica cast
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Displaced fracture (>1mm), proximal pole fracture, athlete needing early return, nonunion
Procedures that may be discussed
- Percutaneous or open Herbert screw fixation — standard for waist fractures
- Vascularized bone graft — for nonunion or proximal AVN
- Partial wrist fusion or arthroplasty — advanced SNAC
Outlook
Non-displaced distal fractures: 95% union with conservative treatment. Proximal pole: 20-40% AVN, nonunion risk — surgery recommended