Obligatory medical device diagnostics. Conventional radiographs of the hand/wrist in 2 planes or 3 standard projections (posterior-anterior (p.-a., dorsopalmar), lateral, and stabbing/dorsopalmar views during fist closure and ulnar reduction) – if fracture is clinically suspected. If necessary, target images of the Os scaphoideum in a special technique (scaphoid quartet/scaphoid in 4 planes). Optional medical device … Scaphoid Fracture: Diagnostic Tests
Indications for surgical therapy: Fracture gap width (fracture gap width) ≥2 mm. Dislocation (displacement or twisting of bones) >1 mm. Long oblique fracture (B1) Zone of debris in the middle third (B2) Fracture of the proximal third (B3) Transscaphoid perilunate dislocation fracture (B4). Legend for B1-B4 – see below “Classification/classification of scaphoid fracture according to … Scaphoid Fracture: Surgical Therapy
The following symptoms and complaints may indicate a scaphoid (navicular) fracture: Pain when the thumb is compressed, in the tabatière (= foveola radialis (Latin: dimple associated with the radius); triangular, elongated depression on the thumb side of the carpus). Swelling in the area of the wrist Restriction of movement
Pathogenesis (development of disease) Scaphoid fracture is usually caused by a fall on the hyperextended hand. Etiology (causes) Injuries, poisonings, and other sequelae of external causes (S00-T98). Fall on the hyperextended hand
Conservative measures Conservative therapy is possible for: Stable type A fractures (see classification below). Stable and non-displaced fracture of the middle third (type A2) (conservative as well as surgical therapy possible). Plaster cast with thumb and forearm inclusion (upper arm plaster splint with thumb inclusion; so-called Böhler plaster cast) – for immobilization. Duration of immobilization … Scaphoid Fracture: Therapy
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes. Joint (abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation) [swelling of wrist area … Scaphoid Fracture: Examination
Laboratory diagnosis – taking into account age and concomitant diseases – is required if surgical action is to be taken.
Medical history (history of illness) is an important component in the diagnosis of scaphoid fracture (scaphoid fracture). Family history Social history Current anamnesis/systemic anamnesis (somatic and psychological complaints). Do you have any pain? Where is the pain localized? Did you have a fall? What was the mechanism of the accident? When was the time of … Scaphoid Fracture: Medical History
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Norm variants/deformities Musculoskeletal system and connective tissue (M00-M99). Osteoarthritis of the wrist Injuries, poisonings and other consequences of external causes (S00-T98). Distortion Dislocation in the carpal region Pathological fracture – bone fracture that occurs without force in a diseased bone. Bruise Radius fracture (salivary fracture) Tendovaginosis – disease … Scaphoid Fracture: Or something else? Differential Diagnosis
The following are the major conditions or complications that may be contributed to by a scaphoid fracture (scaphoid fracture): Musculoskeletal system and connective tissue (M00-M99). Necrosis (tissue death) of the proximal scaphoid fragment. Pseudarthrosis (false joint) Injuries, poisonings and other consequences of external causes (S00-T98). Functional impairment
Classification of scaphoid fracture according to Herbert and Fischer. Type Type description Type A Avulsion fracture or only cortical bone affected Type B Longitudinal/transverse fracture: B1 – oblique/center B2 – transverse / center B3 – proximal B4 – luxation fracture B5 – several larger fragments Type C Multi-fragment fracture Type D Pseudarthrosis (impaired fracture healing … Scaphoid Fracture: Classification
