Case contribution: Dr Radhiana Hassan
Clinical:
- A 27 years old man
- No known medical illness
- Fall while riding a motorbike
- Complaint of pain at right wrist
- Clinical examination shows tenderness at right wrist with minimal swelling.
- Also has limited range of motion
Radiographic findings:
- Scaphoid series performed
- There is a horizontal fracture at waist of right scaphoid
- There is displacement of fracture fragments about 3 mm
- No angulation is seen
- Visualized joints are normal
- No obvious soft tissue swelling
- No radiopaque foreign body
Diagnosis: Scaphoid fracture
Discussion:
- Scaphoid fracture is the most frequent fracture of carpal bones
- It is important to note that radiograph may miss up to 65% of cases
- Scaphoid series are required for better diagnosis.
- MR and bone scan has higher sensitivity than plain radiograph.
- Classification according to location: tubercle, distal pole, waist and proximal pole.
- Classification according to fracture orientation: transverse, horizontal oblique and vertical oblique.
- Fracture displacement of >1mm less favourable prognosis
- Location of fracture influence prognosis; distal fracture usually reunite, middle fracture-failure to reunite in 30% and proximal fracture-failure to reunite in 90%.
- Transverse and horizontal oblique fractures are relatively stable, vertical oblique fracture is unstable (uncommon)
- Complication is avascular necrosis of proximal fragment
Progress of patient:
- Initially treated conservatively with scaphoid cast
- Mini open reduction and screw fixation later done
- Post operative recovery patient was well
