Anatomical snuff box People with scaphoid fractures generally have snuff box tenderness. Vascular supply of the scaphoid comes from two different vascular pedicles. Avascular necrosis AVN is a common complication of a scaphoid fracture. Since the scaphoid blood supply comes from two different vascular branches of the radial artery, fractures can limit access to blood supply. Non union can also occur from undiagnosed or undertreated scaphoid fractures.
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If these repeat films are negative also, then MRI or bone scan if MRI is unavailable should be recommended if clinical suspicion persists 1. CT CT may be used for diagnosis when plain films are normal because it is readily available and quick CT may be insensitive to trabecular injury 5. CT is useful for staging scaphoid fractures if surgery is considered and when fractures of the carpus are extensive or complex.
CT also is useful in assessing bone union 8. MRI MRI is the most sensitive modality for trabecular fractures, and this can detect completely undisplaced fractures, especially in the first 24 hours following injury 9, It is also useful in assessing for avascular necrosis. Nuclear medicine Although bone scans are more sensitive than plain radiograph, they are usually reserved for patients with ongoing pain despite normal serial plain films 8, Bone scans will be most sensitive days following the injury.
An occult fracture will appear as a region of increased uptake, whereas avascular necrosis will demonstrate a photopaenic region at the lower pole of the scaphoid. Hence surgical treatment of displaced fractures or angulation. The bone profile is thought to look like a boat or skiff.
BMJ Books. Read it at Google Books - Find it at Amazon 2. Panoramic versus conventional radiography of scaphoid fractures. MR imaging of clinically suspected scaphoid fractures. Role of MRI in the diagnosis of clinically suspected scaphoid fracture: analysis of consecutive cases and literature review. Emerg Med J. Occult scaphoid fractures: comparison of multidetector CT and MR imaging--initial experience.
Brydie A, Raby N. Early MRI in the management of clinical scaphoid fracture. Br J Radiol. Wrist fractures: what the clinician wants to know. Radiology full text - Pubmed citation.
Fracturas de la Mano
Fracturas del escafoides (navicular)
Fractura de escafoides. Causas, síntomas y tratamiento de fisioterapia
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