Scaphoid fracture
Scaphoid fracture follows a fall onto an outstretched hand and is suspected by anatomic snuffbox tenderness even with a normal initial radiograph; nondisplaced fractures are treated with thumb spica immobilization and displaced or unstable fractures with screw fixation.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
Scaphoid fracture is a fracture of the scaphoid (navicular) carpal bone, the most commonly fractured carpal bone, occurring classically after a fall onto an outstretched hand in young male athletes.
- Epidemiology
The scaphoid is the most commonly fractured carpal bone, reflecting its position on the floor of the anatomic snuffbox where it bears direct load during a fall onto an outstretched hand.
- Risk factors
Fall onto an outstretched hand, by far the dominant mechanism and the historical feature that should raise suspicion in any wrist injury.
- Pathophysiology
Axial load transmitted through a hyperextended, radially deviated wrist during a fall onto an outstretched hand concentrates force on the scaphoid, which bridges the proximal and distal carpal rows…
- Clinical features
Tenderness and swelling in the anatomic snuffbox, the hallmark finding, bounded by the extensor pollicis longus tendon medially and the abductor pollicis longus and extensor pollicis brevis tendons laterally.
- Differential diagnosis
Distal radius fracture: tenderness and swelling centered over the distal radius rather than the anatomic snuffbox, also from a fall onto an outstretched hand, usually visible on initial radiograph.
- Diagnosis
Scaphoid fracture is confirmed radiographically (plain film, or CT/MRI when radiographs are normal but suspicion is high), and the clinching clinical basis for suspecting it before imaging is a fall…
- Management
First, splint every patient with suspected scaphoid fracture (positive exam, regardless of initial radiograph result) in a thumb spica splint while definitive imaging or follow-up is arranged, since…
- Complications
Avascular necrosis of the proximal scaphoid fragment, a direct consequence of the retrograde blood supply being disrupted by the fracture; risk is highest with proximal pole fractures.
- Prognosis
Nondisplaced or minimally displaced fractures diagnosed and immobilized promptly generally heal well with cast or splint treatment alone.
- Prevention
Maintain a high index of suspicion and low threshold to splint any patient with a fall-onto-outstretched-hand mechanism and anatomic snuffbox or scaphoid tubercle tenderness, even with a normal…
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Distal radius fracture
Distal radius fracture is a break of the distal radial metaphysis, classically from a fall onto an outstretched hand, presenting with a dinner-fork or garden-spade wrist deformity and confirmed by wrist radiograph, treated with closed reduction and casting for stable patterns or surgical fixation for displaced, intra-articular, or unstable fractures.
- Carpal tunnel syndrome and median nerve compression
Carpal tunnel syndrome is compression of the median nerve at the wrist causing pain, paresthesia, and eventually weakness in the thumb, index, middle, and radial half of the ring finger, treated first with neutral wrist splinting and, when refractory, with corticosteroid injection or surgical decompression.
- De Quervain tendinopathy
De Quervain tendinopathy is noninflammatory thickening of the abductor pollicis longus and extensor pollicis brevis tendons at the first dorsal wrist compartment, diagnosed clinically by radial wrist pain reproduced on the Finkelstein test. First-line care is rest, NSAIDs, and thumb spica splinting, escalating to corticosteroid injection and then surgical release for refractory cases.
- Extremity fractures
Extremity fractures are diagnosed by focal bony tenderness, deformity, or inability to bear weight/load confirmed on radiograph, and are triaged first for life- and limb-threatening features (hemorrhage, open injury, vascular compromise, compartment syndrome) before definitive fixation decisions. Open fractures need immediate antibiotics and operative debridement, and unstable or displaced patterns need surgical fixation, while stable nondisplaced fractures are managed with reduction and immobilization.
- Osteoporosis
Osteoporosis is low bone strength that raises fragility fracture risk, diagnosed by a hip or spine T-score of -2.5 or less or by a fragility fracture itself. First-line treatment is an oral bisphosphonate, alendronate or risedronate, alongside adequate calcium and vitamin D intake.