Scaphoid series summary radiology reference article. It is situated between the hand and forearm on the thumb side of the wrist also called the lateral or radial side. Clinical outcome of scaphoid malunion as a result of. The extraosseous and intraosseous vascularity of the carpal scaphoid was studied in 15 fresh cadaver specimens by injection and clearing techniques. Scaphoid, nutrient foramina, non union, avascular necrosis. 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. More than 80% of the scaphoid surface is covered with articular cartilage. For more information, you can read a more indepth reference article. The volar scaphoid branch also enters the bone as several perforators. Diagnosis and management of scaphoid fractures american. Current methods of diagnosis and treatment of scaphoid fractures. Ulnar translocation of the wrist open reduction and bridge plating 01. 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. Scaphoid blood flow and acute fracture healing semantic scholar.
Volar branch enters the scaphoid tubercle and supplies its distal 20% to 30%2. The dorsal scaphoid branches from the radial artery enter the nonarticular portion of the scaphoid at the dorsal ridge at the level of the waist and. 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. A scaphoid fracture is a break of the scaphoid bone in the wrist. The length of the scaphoid along the baseline is measured, as it the height of the scaphoid perpendicular to the baseline. A scaphoid series or scaphoid xray may be performed for a multitude of reasons. This has been attributed to its precarious blood supply which is further compromised by the fracture and surgery. A good blood supply of the scaphoid bone from palmar, dorsal. 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. Enter through numerous small foramina along the spiral groove and dorsal ridge. A good blood supply of the scaphoid bone from palmar, dorsal an. The geometry of the scaphoid as it relates to its retrograde blood supply renders it particularly prone to avascular necrosis and other fracture complications. Seventy to eighty percent of the intraosseous vascularity and the entire proximal pole is from.
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 proximal pole depends on blood supply from the distal pole through the scaphoid bone. The blood supply of the scaphoid comes scaphoid fracture is a common injury encountered in family medicine. Delayed union, malunion, or nonunion are often associated with fractures that are inadequately immobilized. 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. Pdf distribution of scaphoid nutrient foramina researchgate. A baseline is drawn along the palmar aspect of the scaphoid. However, they are most commonly used in the assessment of trauma, by clinical teams within the emergency department or orthopedic service. The anatomic snuffbox is generally tender and swelling may occur. Hand anatomy overview bones, blood supply, muscles. Diagnosis and management of scaphoid fractures aafp. Whilst most scaphoid fractures may heal, a number of case series have identified a 10%15% nonunion rate. The heightlength ratio was estimated on the central longitudinal ct slice.
At every stage of treatment, there are controversies. The scaphoid brings together in one definitive reference every aspect of carpal scaphoid injury treatment. No direct blood supply to proximal portion of the bone. Request pdf the blood supply of the scaphoid bone scaphoid vascularisation was investigated using macroscopic and microscopic techniques in 12. Vascular foramina of scaphoid and its clinical implications. The treatment of scaphoid nonunion and malunions has undergone a considerable transition since the 1960 modification of mattis technique by russe. This leaves approximately two thirds of patients with no demonstrable fracture. Fractures of the scaphoid bone mainly occur in young adults and constitute 27% of all fractures. Blood flow is the basic source of life and the scaphoid can present an interesting problem when it breaks. This retrograde blood supply is what can cause a fracture nonunion to go on to avn picture 4. Symptoms can include pain and swelling around the wrist. Scaphoid bone musculoskeletal, skeletal anatomyzone. Pediatric scaphoid fractures treatment of scaphoid fractures fractures of the scaphoid fractures of the scaphoid ununited scaphoid fractures.
There is significant intercarpal motion between scaphoid and lunate, which questions the validity of present kinematic models of carpal motion. The flexibility of the wrist can be largely attributed to its unique and complex composition, marked by. Scaphoid nonunion orif and distal radius bone graft feat. In case of a proximal scaphoid fracture, the blood. It is important for stability and movement at the wrist and may be fractured after a fall onto a hyperextended hand. Scaphoid vascularisation was investigated using macroscopic and. The prevalence of scaphoid fracture ranges from 19, and other fractures collectively from19 to 24. The specific blood supply in combination with the demanding functional requirements can easily lead to disturbed fracture healing. The scaphoid bone is one of the carpal bones of the wrist. 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 scaphoid bone is one of eight small bones in the wrist, called carpal bones. Article information, pdf download for the blood supply of the scaphoid bone, open.
Scaphoid links the proximal and the distal carpal rows. Management for an acute scaphoid fracture begins with. Careful preoperative planning is therefore essential. An animated description of the blood supply to the scaphoid and its impact on fracture healing. Scaphoid fractures can lead to nonunion and avascular necrosis due to interruption of the blood supply. Current methods of diagnosis and treatment of scaphoid. To avoid missing this diagnosis, a high index of suspicion and a thorough history and.
The fracture of the scaphoid bone can cut off the blood supply to one part of the bone which would inhibit the bones ability to heal luckily my daughter fracture was on the good side. The scaphoid is the most commonly fractured carpal bone accounting for 60% of fractures 1, 2. There is a rare accessory bone os centrale carpi that can resemble a fracture. Scaphoid fractures only account for 2% of all fractures but is second only to femoral head for posttraumatic avn. A scaphoid navicular fracture is a break in one of the small bones of the wrist.
Management for an acute scaphoid fracture begins with a reduction. Since blood supply is available from the palmar circulation, a dorsal approach to the scaphoid bone is possible. Symptoms generally includes pain at the base of the thumb which is worse with use of the hand. This is best accomplished with an anteriorly placed interpositional graft along with internal fixation 6.
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. Osteonecrosis of the elbow joint is an often missed diagnosis. The diagnostic strategy of suspected scaphoid fractures, however, is surrounded by controversy. 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. A scaphoid fracture is usually caused by a fall on to an outstretched hand.
The scaphoid bone is one of the carpal bones in your hand around the area of your wrist. Proximal pole has tenuous blood supply and mechanical disadvantage that places it at greater. Ppt scaphoid fractures powerpoint presentation free to. It is the most common carpal bone to break fracture. Scaphoid vascularisation was investigated using macroscopic and microscopic techniques in 12 uninjured, formalin fixed cadaver hands.
The branches course volar and proximal within the bone, supplying 7085% of the scaphoid. 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. This blood supply is easily disrupted, often leaving the proximal portion of the bone without nutrition and leading to osteonecrosis figure 401. The fracture can disrupt the bones blood supply, impairing the healing. 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. Featuring insights from pioneers in the field, its comprehensive coverage extends from standard open procedures to stateoftheart percutaneous methods and miniincision techniques. Nonunion is directly related to an interruption of the tenuous blood supply to the scaphoid. Pdf fractures of the scaphoid, diagnosis and management. A good blood supply of the scaphoid bone from palmar, dorsal and radial vessel groups with a variety of anastomoses was found which should. Scaphoid blood supply two major vascular pedicles1. This is because the blood supply to the bone is variable and can be disrupted by the fracture, impairing bony healing. Healing time in a cast can range from 610 weeks and even longer.
The major blood supply to the scaphoid is via the radial artery. Downloaded from the american family physician web site at. Review of the current methods in the diagnosis and. 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 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. The use of the free vascularised bone graft for nonunion. Scaphoid fractures may be radiologicallyoccult in the acute setting and may result in.
The vascularity of the scaphoid bone sciencedirect. The scaphoid receives its blood supply from a nutrient branch of the radial artery. 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. Esberger from the accident and emergency department, county hospital, lincoln, uk it has been suggested that a positive scaphoid compression test will reliably confirm the presence of a fractured scaphoid in those patients presenting with an injury clinically suggestive of this, but without a fracture visible on initial xrays. Seventy to eight percent of the intraosseous vascularity and the entire. In scaphoid fracturesespecially those in which the bone fragments have become displacedthe blood supply to the bone may be disrupted. The main blood supply to the scaphoid is from the radial artery. Blood supply the primary blood supply comes from the dorsal branch of the radial artery, which divides into 24 branches before entering the waist of the scaphoid along the dorsal ridge.
Scaphoid fiactures and nonunions are a frequent cause of wrist pain. How to draw the blood supply of the scaphoid, frcs orth revision. Blood vessels enter through the dorsal ridge and tuberosity. It enters at the distal pole of the bone and runs to its proximal part. Basic sciences blood supply of the scaphoid youtube. Each chapter covers a different procedure, beginning with a discussion of relevant anatomical. Full text get a printable copy pdf file of the complete article 819k, or click on a page image below to browse page by page. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Displaced scaphoid fractures are seen on radiographs.
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