Due to the importance of scaphoid in wrist mechanics and because of the frequency of the fracture in young adult male, it has an economic as well as physical significance. Rural clinical school ballarat, school of rural health, school of medicine. Even when scaphoid fractures are adequately treated using casts, the reported. A free powerpoint ppt presentation displayed as a flash slide show on id. Uvadare digital academic repository scaphoid fractures. They con cluded that, to assess scaphoid anatomy from. Scaphoid vascularisation was investigated using macroscopic and microscopic techniques in 12 uninjured, formalin fixed cadaver hands. Brigham and womens hospital,boston,ma introduction diagnosis is a challenge. Various classifications of scaphoid fractures have been based on plain radiography, but there are difficulties in defining the actual fracture line without an appreciation of the threedimensional anatomy. Pdf this thesis deals with current issues in anatomy, diagnosis and treatment of scaphoid fractures. Complex motion tomography was used to study the normal orientation of the axes of the proximal and distal scaphoid poles as a basis for comparison with displaced or malunited scaphoid fractures. Current methods of diagnosis and treatment of scaphoid. The scaphoid bone is one of the carpal bones in your hand around the area of your wrist.
Patterson, phd, hisao moritomo, md, satoshi yamaguchi, md, hiromichi mitsuyasu, md, phd, munir shah, md, william l. It is a boatshaped bone that is oriented obliquely with its long axis aligned from the medial portion of the distal radius proximally to the articulation of the 1 st and 2 nd metacarpals distally. Scaphoid definition of scaphoid by the free dictionary. By university of washington featuring thomas trumble. Comprised exclusively of clinical cases covering scaphoid fractures and nonunions, this concise, practical casebook will provide clinicians in orthopedic, plastic and hand surgery with the best realworld strategies to properly diagnose and treat the various forms of the condition they may. This type of fracture occurs most often after a fall onto an outstretched hand. Apr 14, 2015 the scaphoid is a carpal bone in the wrist. Anatomy and biomechanics the scaphoid is a biomechanically important, boatshaped carpal bone from the greek. It is an important structure in the middle of the wrist and is critical for painless and full wrist motion. Ct provides the most precise definition of the osseous anatomy. Scaphoid fractures 9780323485647 us elsevier health. The etymology of the scaphoid bone is derived from the greek skaphe which means a boat, and the greek eidos which means form.
A very common ligament injured during a wrist sprain is the scapholunate ligament. The lunate bone is located centrally in the wrist between the scaphoid and triquetral bones. When applied to the proximal pole of the scaphoid, this showed the venous drainage to be via the dorsal ridge into the venae comitantes of the radial artery. The sagittal images parallel to the long axis of the scaphoid obtained from ct scans provide the best view for determining the extent of collapse. Its anatomy has been described in detail by many authors. It is the most common carpal bone to break fracture. The position of the carpus is influenced proximally by the shape of the radius, ulna, and triangular fibrocartilage and distally by the metacarpals. The scaphoids ligamentous attachments, osseous anatomy, and complex biomechanics predispose this bone to certain ligamentous dysfunctions that lead to osteoarthritis, and certain fracture patterns that lead to malunion or nonunion. The scaphoid bone is the largest bone of the proximal row of wrist bones, its long axis being from above downward.
The joint capsule is slack so as to allow free movement but strong ligaments control the range. Scaphoid bone musculoskeletal, skeletal anatomyzone. Diagnosis and management of scaphoid fractures aafp. A scaphoid fracture is a break in one of the small bones of the wrist. The tendon of the tensor villi palatini grooves it anteriorly and hooks, to reach the soft palate. Distal scaphoid resection arthroplasty for the treatment of degenerative arthritis secondary to scaphoid nonunion malerich et al, jhs 1999 19 pts, all with disi 10% loss carpal height, rl angle 32, avg age 40 avg 12 year duration nonunion fu mean 49 months rom 85% grip 4% 68% complete pain relief. Each chapter covers a different procedure, beginning with a discussion of relevant anatomical. Treatment for a scaphoid fracture can range from casting to surgery, depending on the fractures severity and location on the bone. Scaphoid malunion the significance o f rotational malalignment d. Because of the scaphoid bones poor blood supply, scaphoid fractures can take a longer time to heal than other fractures. This leaves approximately two thirds of patients with no demonstrable fracture. It sits on the radial or lateral side of the wrist near the thumb. Scaphoid series summary radiology reference article. Volar approach to the scaphoid orthopaedicsone articles.
This ligament is in the middle of the wrist between the scaphoid and lunate bones. When it is injured, the scapholunate ligament can be just stretched, causing instability, or may be completely torn. Choose from 500 different sets of quiz anatomy muscles wrist hand flashcards on quizlet. Mfc bone graft for scaphoid nonunion, osteonecrosis, and. Complications may include nonunion of the fracture, avascular necrosis, and arthritis scaphoid fractures are most commonly caused by a fall on an outstretched hand. 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. Symptoms typically include pain and tenderness below the base of the thumb in an area known as the anatomic snuffbox. Advantages provides good exposure of the scaphoid bone.
It gets its name from its crescent shape lunar relating to the moon. Capitate anatomy and osteology with side determination. Viegas, md, phd o treat wrist injuries or degenerative changes, it is essential to understand the anatomy, biomechanics, and function of the wrist, including the carpal ligaments. The diagnosis of scaphoid nonunion is often delayed, and therefore, treatment must be tailored to the type of fracture, the duration of nonunion, and the presence or absence of resulting arthritis. The use of the free vascularised bone graft for nonunion of. Because portions of the scaphoid have a poor blood supplyand a fracture can further disrupt the flow of blood to the bonecomplications with the. A scaphoid fracture is usually caused by a fall on to an outstretched hand. An analysis of 91 acute fractures showed that 11 were apparently incomplete. It is a boatshaped bone that is oriented obliquely with its long axis aligned from the medial portion of the distal radius proximally to the articulation of the 1 st and 2 nd metacarpals distally the scaphoid can be divided into proximal and distal poles.
Starting from the thumb, the eight carpal bones are scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, and hamate. I passed my anatomy test stands for interphase, prophase, metaphase, anaphase and telephase in that order. The scaphoid forms an important mechanical linkage between the proximal and distal carpal rows. The scaphoid bone is one of the carpal bones of the wrist. Because of its complex anatomy, treating scaphoid fractures and nonunions can be. This results from a lack of consensus on the anatomy of the ligaments attaching to the scaphoid and an overwhelming variety of substantially different anatomic. The wrist, or carpal bones going from bottom left to right. Scaphoid, lunate, triquetrum, pisiform then top left to right. To tell the three ts apart triquetrum has tritry in it, and trapezium and trapezoid are in alphabetical order.
Scaphoid fractures are the most common fractures in carpal bones, accounting for 80 to 90% of all carpal fractures. Feb 23, 2017 the scaphoid brings together in one definitive reference every aspect of carpal scaphoid injury treatment. The anatomy of the scaphoid presents a unique challenge when dealing with injury. Request pdf scaphoid anatomy the human scaphoid bone has a unique and complex shape that allows it to function as a critical element in proper wrist biomechanics. Current management of scaphoid nonunion based on the. Scaphoid abdomen definition of scaphoid abdomen by medical. The anatomic snuffbox is generally tender and swelling may occur. On surface anatomy, the scaphoid is located below the anatomic. From a proximal view, during radialulnar deviation of the wrist, the scaphoid exhibits both a. Approximately 80% of the surface of the scaphoid is covered with cartilage to articulate proximally with the distal radius, ulnarly with the lunate and capitate, and distally with the trapezoid and trapezium bone. The most common site of fracture is the waist which is also associated with increased risk of avascular necrosis of the proximal pole as the blood supply of. Provides mustknow information on scaphoid fractures, including how to apply evidencebased management, anatomy, diagnosis, acute fracture management, malunion treatment, and nonunion management. Lower down its projection is in the form of hook like process known as pterygoid hamulus. Scaphoid fractures are uncommon in children because the physis of distal.
A threedimensional laminated paper model of the scaphoid from. Sa also occurs in jejunal atresia and in infants with pyloric stenosis. Scaphoid definition of scaphoid by medical dictionary. Aug 15, 2018 mfc bone graft for scaphoid nonunion, osteonecrosis, and failed prior surgery.
Proximal scaphoid fractures and displaced scaphoid fractures have a worse outcome and might be better off with an open or closed reduction and internal fixation. The extraosseous anatomy is visualised by chemical digestion of the soft tissues, the intraosseous anatomy by clearing the bone using the spalteholz technique. The scaphoid receives its blood supply from both the dorsal and volar branches of the radial artery with the dorsal responsible for 80% of the blood supply including the proximal half of the scaphoid. Near the base of the skull medial pterygoid plate presents the scaphoid fossa. Scaphoid fracture is a common injury encountered in family medicine. It is situated between the hand and the forearm on the thumb side of the wrist also called the lateral, or radial, side. Scaphoid fracture in the elite athlete hand surgery, pc.
In older literature about human anatomy, the scaphoid is referred to as the navicular bone of the hand this time from the latin word. Mfc bone graft for scaphoid nonunion, osteonecrosis, and failed prior surgery. A scaphoid series or scaphoid xray may be performed for a multitude of reasons. The incidence of scaphoid nonunions has been reported to be between 5 and 15%. However, they are most commonly used in the assessment of trauma, by clinical teams within the emergency department or orthopedic service. Fixation techniques have involved nonvascularised bone grafting. Diagnosis and management of scaphoid fractures american. Three strikes but not necessarily out commentary on an article by nicholas pulos, md, et al free vascularized medial femoral condyle bone graft after failed scaphoid nonunion surgery boyer, martin i. The scaphoid is the largest of the proximal row of carpal bones and sits on the radial side of the lunate. Various classifications of scaphoid fractures have been based on plain radiography, but there are difficulties in defining the actual fracture line without an.
Scaphoid fractures and nonunions a clinical casebook. Carpal bone anatomy measured by computer analysis of. Symptoms generally includes pain at the base of the thumb which is worse with use of the hand. Scaphoid fracture and avascular necrosis radiology case. Adequate treatment of scaphoid fractures can result in high rates of union 95100%. In reptiles, birds, and amphibians, this bone is instead commonly referred. The scaphoid lies radially in the wrist 45 to the long axis of.
Presents case scenarios followed by discussions of the importance of the problem, current opinion, evidence, and key recommendations. It is situated between the hand and forearm on the thumb side of the wrist also called the lateral or radial side. Ppt scaphoid fractures powerpoint presentation free to. The scaphoid bone is one of four bones in the proximal row of carpals scaphoid, lunate, triquetrum, pisiform. Blazar md,resident,department of orthopaedic surgery,massachusetts general hospital, boston,ma md,assistant professor,department of orthopaedics,harvard medical school. Symptoms can include pain and swelling around the wrist. In two patients who received a free vascularised osteochondral graft, the. The prevalence of scaphoid fracture ranges from 19, and other fractures collectively from19 to 24. This is a basic article for medical students and other nonradiologists. The wrist and hand joints eastern illinois university. Among their topics are intramedullary screw fixation of the metacarpals and phalanges of the hand, the role of arthroscopy in treating carpal fractures and nonunions, intraarticular fractures of the proximal interphalangeal joint, the correction of malunion in metacarpal and phalangeal fractures, and nonunion of the scaphoid. Diagnosing and treating scaphoid fractures of the wrist. Pdf various classifications of scaphoid fractures have been based on plain radiography.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. One of the largest carpal bones, it is the most lateral and proximal carpal, interposed between. Featuring insights from pioneers in the field, its comprehensive coverage extends from standard open procedures to stateoftheart percutaneous methods and miniincision techniques. Practice using everyday, one word, and every day, two words, in this fun quiz with everyday example sentences. Heatley from the orthopaedic academic unit, united medical and dental schools of guys and st thomass, london, uk the complex shape of the scaphoid and its orientation within the carpus makes the radiological interpretation of scaphoid anatomy difficult. Note normal relationship of proximal and distal poles of scaphoid and smooth dorsal corti. Radiological fracture lines were therefore mapped on transparent methylmethacrylate models of the bone. Abstract the scaphoid is the most frequently fractured carpal bone and prone to. Scaphoid fracture usually occurs due to falling on outstretched hand that lead to hyperextension of the wrist joint.
The specimens were dissected free of soft tissue attachments, and each specimen underwent an osteotomy at a location defined by previous study of the anatomy of acute scaphoid fractures to best. Related anatomy and blood supply scaphoid fractures constitute 6070 % of all carpal bone fracture1. Vascular anatomy is uniquely pertinent as it pertains to the scaphoid and the lunate. Scaphoid series, anatomy and physiology part 92 youtube. The scaphoid brings together in one definitive reference every aspect of carpal scaphoid injury treatment. The scaphoid bone is the largest bone of the proximal row of wrist bones, its long axis being from above downward, lateral, and. Anatomy and physiology mnemonics cellular reproduction stages. This refers to the shape of the bone, supposedly reminiscent of a boat, and in older literature on human anatomy 1 the scaphoid is referred to as the navicular bone of the hand.
Scaphoid nonunion is a common but difficult problem for hand surgeons. 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 scaphoid is the only carpal bone to cross the proximal and distal rows and acts as a strut between them. Learn quiz anatomy muscles wrist hand with free interactive flashcards. Anatomy and mechanism of injury the greek term scaphoid skiff or boat is usually thought to be preferable to the latin term carpal navicular. It has a threedimensionally oblique orientation and performs a unique function as a mechanical link between the distal and. A complex unit of eight carpal bones intricately articulates to form the carpus, figs 1,,, 3. A scaphoid fracture is a break of the scaphoid bone in the wrist.
The scaphoid bone also known as the hand navicular is shaped like a boat, with a major concave surface for the head of the capitate and a major convex surface that articulates with the distal radius. The specimens were dissected free of soft tissue attachments, and each. Current concepts wrist anatomy and biomechanics yasumu kijima, md, steven f. Proper treatment of scaphoid fractures and assessment of fracture healing can. Nonunions are mostly treated operatively by restoring the anatomy to avoid degenerative wrist arthritis. Further therapy options are pedicled bone grafts and free vascularized bone grafts. With or without surgery, patients may need to wear a cast or splint for up to 6 months. It has a bunch of lumpy bits that always end up being important. Biplanar tomograms of 10 normal wrists were evaluated by seven physicians with the use of two standardized measurement techniques. May 04, 2017 the anatomy of the scaphoid presents a unique challenge when dealing with injury.
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