Description

• Scaphoid fractures make up to 70% of all carpal bone fractures in ED setting
• This bone is the stabilizer between the distal and proximal carpal rows
• Injury may result in arthritis, avascular necrosis, or malunion
• Classified as:
  • Proximal 3rd (25%)
  • Middle 3rd (the waist, 65–70%)
  • Distal 3rd (the tuberosity, 5–10%)
  • Tubercle fractures
• Fractures are missed on initial radiographs up to 40% of the time, and delayed diagnosis greatly increases risk of complications
• The majority of the blood supply to the scaphoid enters distally from the dorsal scaphoid artery
• The more proximal the fracture, the higher the likelihood for avascular necrosis; 30% in proximal 3rd fractures
• As the wrist is forcibly hyperextended, the volar aspect of the scaphoid fails in tension and the dorsal aspect fails in compression resulting in a fracture

Etiology

Generally results from a fall on an outstretched (dorsiflexed) hand (FOOSH injury)