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Scaphoid Fractures

History

  • Forcible dorsiflexion of the wrist
  • Palmarflexion in 3% of cases
  • Forcible dorsiflexion of the wrist
  • Palmarflexion in 3% of cases

    Examination

    • Fullness in the ASB indicates an effusion in wrist
    • Careful palpation of all the bony landmarks, with tenderness in the ASB and scaphoid tubercle
    • Pronation followed ulnar deviation will cause pain
  • Fullness in the ASB indicates an effusion in wrist
  • Careful palpation of all the bony landmarks, with tenderness in the ASB and scaphoid tubercle
  • Pronation followed ulnar deviation will cause pain

    Special tests

    • Scaphoid compression test - longitudinal force along the 1st metacarpal
    • Kirk-Watson's test
    • Resisted pronation
  • Scaphoid compression test - longitudinal force along the 1st metacarpal
  • Kirk-Watson's test
  • Resisted pronation

    X-ray

    • Good quality films are required
    • 1. PA in ulnar deviation
    • 2. Lateral with wrist in neutral
    • 3. Scaphoid view 1: PA 45deg. pronation & ulnar deviation; + shows STT joint     [Picture]
    • 4. Scaphoid view 2: AP with 30deg supination & ulnar deviation; + shows radioscaphoid joint     [Picture]
    • Others:
      • PA with wrist in slight extension (Ziter view)
      • AP with clenched fist to detect a ligamentous injury
  • Good quality films are required
  • 1. PA in ulnar deviation
  • 2. Lateral with wrist in neutral
  • 3. Scaphoid view 1: PA 45deg. pronation & ulnar deviation; + shows STT joint     [Picture]
  • 4. Scaphoid view 2: AP with 30deg supination & ulnar deviation; + shows radioscaphoid joint     [Picture]
  • Others:
    • PA with wrist in slight extension (Ziter view)
    • AP with clenched fist to detect a ligamentous injury

    False negative rate:

    • Leslie and Dickson 1981 2%
    • Munk et al. 1995 6%
    • Leslie and Dickson 1981 2%
    • Munk et al. 1995 6%


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