Scaphoid fracture

Case contribution: Dr Radhiana Hassan


  • 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


  • 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

Author: radhianahassan