(Moreover, an immediate MRI can spare one the hassles of immobilization for weeks for what turns out to be a bruise. While use of MRI is not the standard of care across the country, it can eliminate the need for unnecessary immobilization and potentially prove to be more cost effective than repeat visits and x-rays. In some cases, a patient will initially undergo an MRI to rule out a displaced scaphoid fracture following a negative x-ray. Includes 15 X-rays of femoral shaft fracture, radius fracture, supracondylar humerus fracture, phalangel fracture. (The logic is that if a fracture were present, either a fracture line or a healing response will be seen.) Hold up to the light or use on a light table. The standard of care for a potential scaphoid fracture is preventative immobilization for 2-3 weeks followed by repeat radiographic imaging. The loss of blood supply will of courseĭeprive the bone of oxygenation and nutrients. the middle third of the bone) will interruptīlood supply to the proximal pole. (Because of this, the blood supply to the scaphoid is termedīecause of this retrograde blood supply, displacement of a fractureĪcross the scaphoid waist (i.e. As such, the scaphoid is perfused in the distal to The scaphoid receives its primary blood supply from theĭorsal scaphoid branches of the radial artery, which enter the scaphoid at a (The talus, anotherĬartilage-covered bone, is also one prone to osteonecrosis.) The dorsal carpal branch of the radial artery. Leaving only a small area on the scaphoid for arterial blood to enter the bone via The scaphoid’s surface is largely covered in cartilage, Displacement is bad in and of itself, but in theĬase of a displaced scaphoid fracture, there is an increased risk of osteonecrosisīecause of the scaphoid’s (so-called) retrograde blood supply. Immobilization of the wrist is crucial to preventĭisplacement of any fracture that may be present, and in turn, prevent osteonecrosisĬlearly, nondisplaced fractures are at risk of displacement Tenderness, the wrist should be immobilized. In cases where the x-ray is negative but there is snuff box Wrist and palm, it can be difficult to detect nondisplaced fractures on routine The scaphoid lies directly below the skin here.īecause the scaphoid is not perfectly parallel with the The medial (ulnar) border is the extensor pollicis longus tendon. Figure 3: the white arrow points to the center of “anatomic snuff box.” The lateral (radial/thumb sided) border is formed by the extensor pollicis brevis and abductor pollicis longus tendons.
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