Management for an acute scaphoid fracture begins with a reduction. Since the scaphoid blood supply comes from two different vascular branches of the radial artery, fractures can limit access to blood supply. The ability of eswt to enhance microcirculation parameters in soft tissue was of interest to determine if it improves microcirculation in the. 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. The extraosseous and intraosseous blood supply of the scaphoid. Dec 18, 2017 scaphoid fractures can lead to nonunion and avascular necrosis due to interruption of the blood supply. Featuring insights from pioneers in the field, its comprehensive coverage extends from standard open procedures to stateoftheart percutaneous methods and miniincision techniques. Scaphoid blood supply two major vascular pedicles1. The scaphoid brings together in one definitive reference every aspect of carpal scaphoid injury treatment. Scaphoid fractures and blood supply nabil ebraheim medium. Scaphoid fractures usually result from wrist hyperextension, typically during a fall on an outstretched hand.
Narrow area of its waist and even smaller distal portion, are accessible to blood vessels distally, it articulates with the trapezium and trapezoid in a. This blood supply is easily disrupted, often leaving the proximal. 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. Learningradiology avascular necrosis of the scaphoid, navicular. The blood supply from the scaphoid dorsal ridge plays an important role, not only for the proximal part of the scaphoid, but also for the waist and even the distal pole.
Excision of the radial styloid as a bone graft for scaphoid nonunion. Resection of the distal scaphoid has been proposed as a surgical alternative in early osteoarthritis 6,9,11. This is best accomplished with an anteriorly placed interpositional graft along with internal fixation 6, 1722. A separate volar arterial branch to the scaphoid enters the tubercle and accounts for 2030% of the scaphoids blood supply, mainly to the distal. The scaphoid bone is the largest bone of the proximal row of wrist bones, its long axis being from above downward, lateralward, and forward. To avoid missing this diagnosis, a high index of suspicion and a thorough history and. It is located on the radial side of the wrist, and articulates with the radius, lunate, trapezoid, trapezium and capitate. Nonunion is directly related to an interruption of the tenuous blood supply to the scaphoid. The scaphoid bone is one of the carpal bones of the wrist. Current methods of diagnosis and treatment of scaphoid fractures. Epidemiology scaphoid fractures account for 7080% of all carpal bone.
If adequate reduction of the scaphoid fracture cannot be achieved, then a combined palmar approach. The scaphoid is the most commonly fractured carpal bone accounting for 60% of fractures 1, 2. The scaphoid bone is stronger than the relative weak distal radius compared in. Microcirculation is an important factor in bone healing and may be compromised in fractured scaphoids because its blood supply comes from the distal end. It is an irregularly shaped tubular bone, twisted and bends into sshape. Treatment of scaphoid fractures and nonunions hand therapy hub. Seventy to eight percent of the intraosseous vascularity and the entire. The use of the free vascularised bone graft for nonunion of. Interferes with the dorsal blood supply of the scaphoid. Enter through numerous small foramina along the spiral groove and dorsal ridge. Isolated dislocation of the carpal scaphoid is an extremely rare injury. Xrays are routinely taken of the scaphoid as it heals.
The major blood supply to the scaphoid is via the radial artery. Approximately 80% of the scaphoid bone surface is covered with cartilage. The role of multidetector computed tomography in diagnosis. Scaphoid links the proximal and the distal carpal rows. Diagnosis and treatment of scaphoid fractures, can nonunion. It is important for stability and movement at the wrist and may be fractured after a fall onto a hyperextended hand. Sometimes a scaphoid non union is found quite by chance when xrays are taken of the wrist for other reasons. Bipartite scaphoids may be unilateral or bilateral. Scaphoid fractures only account for 2% of all fractures but is second only to femoral head for posttraumatic avn. Endangers the superficial branch of the radial nerve. It didnt take any time at all to decide on surgery, just which type of surgery. Anatomic locking plate fixation for scaphoid nonunion. Biomechanics mechanically scaphoid links the proximal and distal rows. 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.
It is situated between the hand and forearm on the thumb side of the wrist also called the lateral or radial side. 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 carti. Taleisnik and kelly7 reported that the vascular supply of the scaphoid does not. Original article treatment of scaphoid nonunion with. Waldman md, jd, in atlas of uncommon pain syndromes third edition, 2014. The scaphoid does not have any tendinous attachments. Diagnosis and management of scaphoid fractures american. Mar 19, 2015 an animated description of the blood supply to the scaphoid and its impact on fracture healing. Scaphoid fractures musculoskeletal medicine for medical. Volar branch enters the scaphoid tubercle and supplies its distal 20% to 30%2. Apr 22, 20 scaphoid blood supply two major vascular pedicles1.
Fixation techniques have involved nonvascularised bone grafting. Fractures in the proximal have a high incidence of avn 30%. Despite various modalities of treatment this injury continues to present problems for patient and surgeon alike. Bipartite scaphoids may be unilateral or bilateral diagnostic criteria have been proposed 3 no history of traumatic injury. Scaphoid fractures may be radiologicallyoccult in the acute setting and may result in. Scaphoid represent floor of the anatomic snuff box. This is especially true for proximal scaphoid fractures due to retrograde blood supply. A good blood supply of the scaphoid bone from palmar, dorsal and radial vessel groups with a variety of anastomoses was found which should. The scaphoid is situated between the proximal and distal rows of carpal bones. Its unique morphology from its boat like shape to its retrograde blood supply can present with challenges in the. The treatment of scaphoid nonunion and malunions has undergone a considerable transition since the 1960 modification of mattis technique by russe.
The dorsal approach is a simpler approach, is better for very small proximal fragments, but may interfere more with the blood supply of the scaphoid. How to draw the blood supply of the scaphoid, frcs orth revision. May 10, 2015 anatomy scaphoid is the largest bone of proximal carpal row. The extraosseous blood supply is primarily derived from a branch of the radial artery, the artery to the. Due to this perfusion pattern, the scaphoid bone is prone to nonunion after fracture.
The scaphoid is vitally important for the proper mechanics of wrist function. Basic sciences blood supply of the scaphoid youtube. The palmar surface of the scaphoid is concave, and forming a tubercle, giving attachment. Different methods include manual reduction in which two people pull in the. Excision of the proximal fragment of a nonunited scaphoid. The blood supply to the scaphoid can be divided into extraosseous and intraosseous sources. Scaphoid nonunion s caphoid nonunion is challenging to manage because of the geometry of the scaphoid, the direction andtypeoffracture,andthevascular pattern of the blood supply to the scaphoid. An animated description of the blood supply to the scaphoid and its impact on fracture healing. Each chapter covers a different procedure, beginning with a discussion of relevant anatomical.
Blood vessels enter through the dorsal ridge and tuberosity. A dorsal branch of the radial artery accounts for 80% of the blood supply of the scaphoid. Primary supply of blood comes from dorsal branch of radial artery which enters at the waist of the scaphoid. Pdf current methods of diagnosis and treatment of scaphoid. Combining data from several recent studies, yin et al. They can disrupt the blood supply to the proximal scaphoid. There is controversy whether this condition is congenital i. The use of the free vascularised bone graft for nonunion.
If a scaphoid fracture was seen on scaphoid radiographs, patients were immobilized in a plaster cast. A bipartite scaphoid is a rare example of a divided carpus. Over 80% of the bone is covered in articular cartilage. Many surgical procedures been advocated for the treatment of the scaphoid which suggests that difficulties exist in this problem and that no method has been uni. The specific blood supply in combination with the demanding functional requirements can easily lead to disturbed fracture healing. Fractures of the scaphoid bone mainly occur in young adults and constitute 27% of all. The proximal pole of the scaphoid relies entirely on intramedullary blood flow. Scaphoid fractures can lead to nonunion and avascular necrosis due to interruption of the blood supply. Dec 08, 2016 how to draw the blood supply of the scaphoid, frcs orth revision. Osteonecrosis of the elbow joint is an often missed diagnosis.
The authors report herein a case of a 28yearold man managed with open reduction and kirschner wire fixation. The major blood supply to the scaphoid is a branch of the radial artery that enters. Jul 23, 2009 the reason for this high incidence of avn in cases of proximal pole fractures is thought to be due to the tenuous blood supply of the scaphoid. Because the scaphoid has a blood supply which comes from only one side it is prone to not healing. If the radiographs were negative or dubious for scaphoid fracture, patients were referred for three phase bone scintigraphy. Therefore, in the scaphoid fracture, the arterial blood supply to the proximal pole may be interrupted.
The purpose of this paper is to present medium term results of distal scaphoid. The main arterial blood supply is retrograde coming from the radial artery branch. Next, the nonunion of the scaphoid is visualized and the sclerotic bone ends are freshened with a power drill. Avascular necrosis avn is a common complication of a scaphoid fracture. Management for an acute scaphoid fracture begins with. There is significant intercarpal motion between scaphoid and lunate, which questions the validity of present kinematic models of carpal motion. May 22, 20 blood vessels enter through the dorsal ridge and tuberosity. As such, the scaphoid is perfused in the distal to proximal direction retrograde blood supply.
The scaphoid is the largest of the proximal row of carpal bones and sits on the radial side of the lunate. Feb 04, 20 a dorsal branch of the radial artery accounts for 80% of the blood supply of the scaphoid. Scaphoid vascularisation was investigated using macroscopic and microscopic techniques in 12 uninjured, formalin fixed cadaver hands. Scaphoid spans both carpal rows and therefore has less mobility than other carpal bones. Branches course proximally making the proximal pole at risk for avn if the bloody supply is compromised at the waist or proximal pole by a fracture.
Scaphoid fixation can be quite difficult due to the cashew nut shape and the need to place the screw in the midaxis of the scaphoid, without violating the radial and ulnar articular surfaces. Any information contained in this pdf file is automatically generated from digital material submitted to. Risk of avn depends on the location of the fracture. Dorsal approach to the scaphoid orthopaedicsone articles. Scaphoid fixation approaches cambridge orthopaedics. In case of a proximal scaphoid fracture, the blood supply through the.
Pseudarthrosis of the scaphoid in immature skeletons scielo. Osteonecrosis is thus a common complication, even when initial care is optimal, and can cause disabling, degenerative arthritis of the wrist. Blood supply to the scaphoid bone is predominantly from branches of the radial. There have been a number of techniques described for bone grafting 5, 6 with or without headless screw fixation to facilitate fracture healing. Fractures of the scaphoid are well known to be problematic especially when complicated by avascular necrosis, nonunion and carpal collapse. It sits on the radial or lateral side of the wrist near the thumb.
Scaphoid surgery recovery time i know the nhs is a nightmare when i first went to xray after having pain in the wrist for around a year i play rugby and just strapped it up they told me there was no fracture. 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. Whilst most scaphoid fractures may heal, a number of case series have identified a 10%15% nonunion rate. Fracture proximal to the perforating vessels on the dorsoradial surface of the scaphoid can cause significant bone ischemia of the proximal pole. 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. In order to evaluate the diagnostic management of scaphoid fracture, 100 consecutive patients with clinically suspected scaphoid fractures were investigated. Scaphoid carries the compressive loads from the hand across the wrist to the distal forearm. 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. A separate volar arterial branch to the scaphoid enters the tubercle and accounts for 2030% of the scaphoids blood supply, mainly to the distal portion. The blood supply of the scaphoid comes scaphoid fracture is a common injury encountered in family medicine. The extraosseous and intraosseous vascularity of the carpal scaphoid was studied in 15 fresh cadaver specimens by injection and clearing techniques. Apr 14, 2015 the scaphoid is a carpal bone in the wrist.
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