Introduction
The scaphoid fracture is divided into two categories: The scaphoid is divided into three thirds. 5 % of all fractures affect the third far from the wrist (distal third), 80 % affect the middle third and about 15 % affect the third near the wrist (proximal third). Due to the blood flow situation, proximal fractures have the worst prognosis with regard to fracture healing. Fractures are differentiated from horizontal, transverse and vertically oblique fractures.
- Regarding the localization
- Regarding the fracture pattern
- Fracture of the distal portion
- Breakage of the middle portion
- Fracture of the proximal portion
- Oblique break
- Transverse fracture
- Transversal Transverse Fracture
Diagnosis
The first step in suspecting a scaphoid fracture is an X-ray of the scaphoid in four planes (scaphoid – quartet). If a scaphoid fracture cannot be detected initially, but the clinical symptoms indicate a scaphoid fracture, the x-rays can be repeated after 10 – 14 days. In an MRI of the hand (magnetic resonance imaging of the hand) the bony structures cannot be assessed as well as in a computed tomography.
MRI has advantages with regard to the assessment of ligament structures. In the case of a fresh fracture, reactive water retention (bone bruise) can be detected in the MRI. X-ray image of the wrist
- Scaphoid bone (Os scaphoideum)
- Moon leg (Os lunatum)
- Pea leg (Os pisiforme)
- Triangle leg (Os triquetum)
- Hooked leg (Os hamatum)
- Capitate bone (Os capitatum)
- Small polygon bone (Os trapezoidum)
- Large polygonal bone (Os trapezium)
In comparison to the above image, the right image is an MRI image.
The red arrow points to the scaphoid (yellow). The red-brown area points to a spot that becomes very stained when contrast medium is administered, as a sign of increased water retention. This can also be called a bump of the bone and can only be seen on the MRI. It is evidence of an accident that has taken place. After one week, a skeletal scinitgraphy shows a significantly increased bone metabolism in the area of the scaphoid during fracture healing.In summary, computed tomography (CT), magnetic resonance imaging (MRI) and skeletal scintigraphy are diagnostic procedures that are only used in exceptional cases to confirm a diagnosis so that a scaphoid fracture cannot be overlooked.