A fracture of the scaphoid which can result from a fall onto an outstretched hand can, therefore, lead to avascular necrosis of the proximal bony fragment. The palmar surface of the scaphoid is concave, and forming a tubercle, giving attachment. The scaphoid bone, also called the navicular bone, is the largest bone in the proximal row of the wrist, the highly flexible region between the forearm and the hand. No direct blood supply to proximal portion of the bone. Avascular necrosis avn is a common complication of a scaphoid fracture. The scaphoid bone is one of the carpal bones in your hand around the area of your wrist.
These coils supply a 15 hz pulsed quasirectangular electrical signal. A scaphoid fracture is usually caused by a fall on to an outstretched hand. The anatomic snuffbox is generally tender and swelling may occur. Symptoms can include pain and swelling around the wrist. Volar approach to the scaphoid orthopaedicsone articles. Blood flow to the scaphoid bone occurs via retrograde backwards flow, meaning blood enters at the distal top portion of the bone and there is no direct blood supply to the proximal bottom portion of the bone. The scaphoid brings together in one definitive reference every aspect of carpal scaphoid injury treatment. Segmental fracture of the scaphoid bmj case reports. This blood supply is easily disrupted, often leaving the proximal portion of the bone without nutrition and leading to osteonecrosis figure 401. Review of the current methods in the diagnosis and treatment. The scaphoid tubercle is a bony prominence on the ventral surface of the lateral portion of the distal pole.
May 1986 nonunited scaphoid fractures treated by pemf and cast 345 fig. However, they are most commonly used in the assessment of trauma, by clinical teams within the emergency department or orthopedic service. The extraosseous and intraosseous blood supply of the scapho. For this type of fracture, your doctor may place your forearm and hand in a cast or a splint.
Scaphoid blood supply two major vascular pedicles1. It is situated between the hand and forearm on the thumb side of the wrist also called the lateral or radial side. As such, the scaphoid is perfused in the distal to proximal direction retrograde blood supply. The distal pole is supplied by both the palmar scaphoid branch of the superficial palmar branch of. In scaphoid fracturesespecially those in which the bone fragments have become displacedthe blood supply to the bone may be disrupted. Scaphoid has unique anatomy to its credit when surrounding bones and its arterial supply is considered.
In case of a proximal scaphoid fracture, the blood supply through the scaphoid bone is interrupted, making. The prevalence of scaphoid fracture ranges from 19, and other fractures collectively from19 to 24. The scaphoid can be divided into proximal and distal poles. Clinical outcome of scaphoid malunion as a result of scaphoid. To avoid missing this diagnosis, a high index of suspicion and a thorough history and. The use of the free vascularised bone graft for nonunion. It is located on the radial side of the wrist, and articulates with the radius, lunate, trapezoid, trapezium and capitate. For more information, you can read a more indepth reference article. Scaphoid fractures musculoskeletal medicine for medical students. Enter through numerous small foramina along the spiral groove and dorsal ridge. Scaphoid fractures account for 50%80% of carpal bone fractures in young adults. Each chapter covers a different procedure, beginning with a discussion of relevant anatomical.
The scaphoid fracture first described in 1905 by destot, a french surgeon, anatomist and radiologist, 1 derives its name from the greek word skaphos meaning boat. Fractures of the scaphoid are well known to be problematic especially when complicated by avascular necrosis, nonunion and carpal collapse. Since the scaphoid blood supply comes from two different vascular branches of the radial artery, fractures can limit access to blood supply. The use of the free vascularised bone graft for nonunion of. Featuring insights from pioneers in the field, its comprehensive coverage extends from standard open procedures to stateoftheart percutaneous methods and miniincision techniques. Apr 22, 20 scaphoid blood supply two major vascular pedicles1. A good blood supply of the scaphoid bone from palmar, dorsal. How to draw the blood supply of the scaphoid, frcs orth revision.
The palmar approach further runs the risk of devascularising the proximal part of the scaphoid because the main blood supply that comes in through the dorsum is not visualised. The blood supply of the scaphoid comes scaphoid fracture is a common injury encountered in family medicine. Pdf fractures of the scaphoid, diagnosis and management. Most of the blood supply derives from branches of the radial artery that penetrate the scaphoid distally and supply 70%80% of the more proximal bone, thus giving rise to the problem of a higher rate of nonunion and avascular necrosis in more proximal fractures. The scaphoid also known as the os scaphoideum or historically as the navicular is the largest of the proximal row of carpal bones and forms the radial portion of the carpal tunnel.
Complications may include nonunion of the fracture, avascular necrosis, and arthritis scaphoid fractures are most commonly caused by a fall on an outstretched hand. Management for an acute scaphoid fracture begins with. Hand anatomy overview bones, blood supply, muscles geeky. Fixation techniques have involved nonvascularised bone grafting. The scaphoid receives its primary blood supply from the dorsal scaphoid branches of the radial artery, which enter the scaphoid at a point near the distal pole. The scaphoid bone is one of the carpal bones of the wrist. It is important for stability and movement at the wrist and may be fractured after a fall onto a hyperextended hand. Scaphoid blood flow and acute fracture healing semantic scholar.
This method places inductive electromagnetic coils on opposite sides of the fracture site. Symptoms generally includes pain at the base of the thumb which is worse with use of the hand. The flexibility of the wrist can be largely attributed to its unique and complex composition, marked by. Since blood supply is available from the palmar circulation, a dorsal approach to the scaphoid bone is possible. Displaced scaphoid fractures are seen on radiographs. There is significant intercarpal motion between scaphoid and lunate, which questions the validity of present kinematic models of carpal motion. Due to its poor blood supply, healing of a fractured scaphoid can be difficult but is important to wrist function and longterm health. This leaves approximately two thirds of patients with no demonstrable fracture. A 30yearold man presented with a symptomatic 15yearold right scaphoid fracture with secondary scaphoid nonunion advanced collapse of his right wrist. A scaphoid series or scaphoid xray may be performed for a multitude of reasons. Current methods of diagnosis and treatment of scaphoid. Scaphoid fractures only account for 2% of all fractures but is second only to femoral head for posttraumatic avn. The length of the scaphoid along the baseline is measured, as it the height of the scaphoid perpendicular to the baseline. May 22, 20 blood vessels enter through the dorsal ridge and tuberosity.
This part of the scaphoid bone has a good blood supply, which is necessary for healing. Treatment of nonunited scaphoid fractures by pulsed. Nov 23, 2019 this unusual flow of blood in the scaphoid presents a problem when you sustain a scaphoid fracture. An animated description of the blood supply to the scaphoid and its impact on fracture healing. The extraosseous and intraosseous vascularity of the carpal scaphoid was studied in 15 fresh cadaver specimens by injection and clearing techniques. Scaphoid vascularisation was investigated using macroscopic and. Scaphoid fractures can lead to nonunion and avascular necrosis due to interruption of the blood supply. Risk of avn depends on the location of the fracture. Over 80% of the bone is covered in articular cartilage. A good blood supply of the scaphoid bone from palmar, dorsal and radial vessel groups with a variety of anastomoses was found which should provide sufficient collateral blood flow from adjacent regions in some patients. Osteonecrosis is said to occur in %50% of cases of fracture of the scaphoid, and the incidence of osteonecrosis is even higher in those with involvement of the proximal one. This blood supply is easily disrupted, often leaving the proximal. Because of the tenuous blood supply, a scaphoid fracture can sever this blood flow and stop the delivery of necessary oxygen and nutrients to the bone cells. Jfb free fulltext characterization of a preclinical.
Large animal models are the most reliable method to evaluate the efficacy of new treatment modalities before their translation into clinical practice. Review of the current methods in the diagnosis and. When this occurs, healing can be slow, and the scaphoid fracture may not heal at all. Waldman md, jd, in atlas of uncommon pain syndromes third edition, 2014. Fractures of the scaphoid bone mainly occur in young adults and constitute 27% of all fractures. Scaphoid has unique anatomy to its credit when surrounding bones and. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Dec 18, 2017 scaphoid fractures can lead to nonunion and avascular necrosis due to interruption of the blood supply.
The scaphoid bone is the largest bone of the proximal row of wrist bones, its long axis being from above downward, lateralward, and forward. The blood supply of the scaphoid is primarily from the radial artery via the artery to the dorsal ridge of the scaphoid, whose branches enter the scaphoid via. Scaphoid fractures musculoskeletal medicine for medical. They can disrupt the blood supply to the proximal scaphoid. Avoids damaging the dorsal blood supply to the bones proximal half. In surgical treatment, holes are drilled and a screw is placed across the fracture to realign the bones and support the site while it heals. The scaphoid bone forms part of the wrist joint and interacts with the radius. A scaphoid fracture is a break of the scaphoid bone in the wrist. There is a rare accessory bone os centrale carpi that can resemble a fracture. A good blood supply of the scaphoid bone from palmar, dorsal an. Scaphoid nonunion affects wrist joint function and is often associated with a predictable pattern of degenerative change.
The waist between the two is the commonest site of scaphoid fracture. The vascularity of the scaphoid bone sciencedirect. Normal scaphoid anatomy slide 1 and blood supply slide 2 mechanism of injury and classification of scaphoid fractures slide 3 and their complications nonunion, osteonecrosis, snac wrist imaging of scaphoid fractures including radiography, mri, ct, ultrasonography, and bone scan. This retrograde blood supply is what can cause a fracture nonunion to go on to avn picture 4. The scaphoid bone is one of eight small bones that make up the carpal bones of the wrist. The scaphoid is the most commonly fractured carpal bone accounting for 60% of fractures 1, 2.
Seventy to eight percent of the intraosseous vascularity and the entire. Scaphoid series summary radiology reference article. The scaphoid blood supply comes from the dorsal branch of the radial artery coursing retrograde proximal 80% of scaphoid and superficial palmar arch distal 20% of scaphoid. The proximal pole depends on blood supply from the distal pole through the scaphoid bone. It is the most common carpal bone to break fracture. Scaphoid fractures and blood supply nabil ebraheim medium. Scaphoid links the proximal and the distal carpal rows. Scaphoid fractures may be radiologicallyoccult in the acute setting and may result in.
Ppt scaphoid fractures powerpoint presentation free to. Osteonecrosis of the elbow joint is an often missed diagnosis. Management for an acute scaphoid fracture begins with a reduction. Imaging and treatment of scaphoid fractures and their. Current methods of diagnosis and treatment of scaphoid fractures. Scaphoid vascularisation was investigated using macroscopic and microscopic techniques in 12 uninjured, formalin fixed cadaver hands. Scaphoid fracture causes, symptoms, diagnosis, and treatment. Careful preoperative planning is therefore essential.
Owing to its tenuous blood supply, the scaphoid is particularly susceptible to osteonecrosis and ensuing posttraumatic arthrosis after fracture. Clinical outcome of scaphoid malunion as a result of. Blood vessels enter through the dorsal ridge and tuberosity. The heightlength ratio was estimated on the central longitudinal ct slice. Fractures in the proximal have a high incidence of avn 30%. Nonunion is directly related to an interruption of the tenuous blood supply to the scaphoid. The scaphoid receives its blood supply from a nutrient branch of the radial artery. Osteonecrosis is thus a common complication, even when initial care is optimal, and can cause disabling, degenerative arthritis of. Osteonecrosis is said to occur in %50% of cases of fracture of the scaphoid, and the incidence of osteonecrosis is even higher in those with involvement of the proximal onefifth of the scaphoid.
Management of a 15yearold scaphoid nonunion bmj case reports. May 10, 2015 rule of 70s for scaphoid 70% of all carpal fractures occur at scaphoid. The major blood supply to the scaphoid is via the radial artery. Management of a 15yearold scaphoid nonunion bmj case. A baseline is drawn along the palmar aspect of the scaphoid. A fractured scaphoid is a common disabling injury that is frequently complicated by nonunion. Sep 23, 2016 so, there is a risk that if you have a fracture in this area, it can sometimes stop the blood supply to part of the scaphoid bone, leaving part of the bone without a blood supply. Mar 19, 2015 an animated description of the blood supply to the scaphoid and its impact on fracture healing. The specific blood supply in combination with the demanding functional requirements can easily lead to disturbed fracture healing. Whilst most scaphoid fractures may heal, a number of case series have identified a 10%15% nonunion rate.
Diagnosis and management of scaphoid fractures american. The diagnostic strategy of suspected scaphoid fractures, however, is surrounded by controversy. This limited arterial supply to the proximal portion, is clinically significant in scaphoid fractures which are very common injuries following a fall on an outstretched hand and can result in avascular necrosis of the proximal segment, or other complications such as nonunionmalunion. Like the scaphoid bone of the wrist, the elbow joint is extremely susceptible to this disease because of the tenuous blood supply of the articular cartilage. Basic sciences blood supply of the scaphoid youtube. The scaphoid is situated between the proximal and distal rows of carpal bones. The treatment of nonunion remains challenging because of the scaphoids small size and delicate blood supply. The scaphoid does not have any tendinous attachments. Hand anatomy overview bones, blood supply, muscles.
It enters at the distal pole of the bone and runs to its proximal part. Vascular foramina of scaphoid and its clinical implications. Article information, pdf download for the blood supply of the scaphoid bone, open. Scaphoid fractures usually result from wrist hyperextension, typically during a fall on an outstretched hand. Seventy to eighty percent of the intraosseous vascularity and the entire proximal pole is from. In case of a proximal scaphoid fracture, the blood. Scaphoid bone musculoskeletal, skeletal anatomyzone. The initial injury was from a fall onto his outstretched hand.
The extraosseous and intraosseous blood supplies of the scaphoid were determined in eleven human spe. Delayed union, malunion, or nonunion are often associated with fractures that are inadequately immobilized. Scaphoid fractures that are closer to the thumb distal pole usually heal in a matter of weeks with proper protection and restricted activity. Request pdf the blood supply of the scaphoid bone scaphoid vascularisation was investigated using macroscopic and microscopic techniques in 12. Rule of 70s for scaphoid 70% of all carpal fractures occur at scaphoid. Volar branch enters the scaphoid tubercle and supplies its distal 20% to 30%2. A good blood supply of the scaphoid bone from palmar, dorsal and radial vessel groups with a variety of anastomoses was found which should. Dec 08, 2016 how to draw the blood supply of the scaphoid, frcs orth revision.
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