Most commonly, a fracture occurs at the narrowest part of the scaphoid known as the waist. 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. This complication is influenced by delayed diagnosis, gross displacement, associated injuries of the carpus, and impaired blood supply. Fracture proximal to the perforating vessels on the dorsoradial surface of the scaphoid can cause significant bone ischemia of the proximal pole. 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. 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. Scaphoid fractures can lead to nonunion and avascular necrosis due to. The blood supply of the scaphoid bone sage journals. The ability of eswt to enhance microcirculation parameters in soft tissue was of interest to determine if it improves microcirculation in the. The scaphoid bone is vulnerable to fracture because of its position within the wrist and its role in wrist function.
Seventy to eighty percent of the intraosseous vascularity and the entire proximal pole is from. 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. The blood supply of the scaphoid is unique and tenuous. Because blood supply is needed to heal a fracture, the scaphoid often takes a long time a few months to heal. Current methods of diagnosis and treatment of scaphoid fractures. We have remained at the forefront of medicine by fostering a culture of collaboration, pushing the boundaries of medical research, educating the brightest medical minds and maintaining an unwavering commitment to the diverse communities we serve.
Pdf fractures of the scaphoid, diagnosis and management. This blood supply is tenuous, increasing the risk of nonunion, particularly with fractures at the wrist and proximal end. It is important for stability and movement at the wrist and may be fractured after a fall onto a hyperextended hand. The blood supply to the scaphoid is tenuous and, if disrupted by the fracture, healing may be compromised. If not treated correctly nonunion of the scaphoid fracture can lead to wrist osteoarthritis. Scaphoid fractures and blood supply nabil ebraheim medium. However, this concept has not been entirely supported by the results of more recent. The scaphoid bone is the most radial of the carpal bones and.
Vascular foramina of scaphoid and its clinical implications. 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. Scaphoid fractures that do not heal are referred to as a. Microcirculation is an important factor in bone healing and may be compromised in fractured scaphoids because its blood supply comes from the distal end. If the scaphoid fracture is nondisplaced bone has not moved out of place at the fracture, it usually can be successfully treated with a cast. To avoid missing this diagnosis, a high index of suspicion and a thorough history and. Avascular necrosis an overview sciencedirect topics. The palmar blood supply accounts for 20% to 30% of the total blood supply, mostly in the distal pole.
The radial artery is the primary source of blood supply to the scaphoid. The extraosseous and intraosseous vascularity of the carpal scaphoid was studied in 15 fresh cadaver specimens by injection and clearing techniques. A good blood supply of the scaphoid bone from palmar, dorsal and radial vessel groups with a variety of anastomoses provide sufficient collateral blood flow from adjacent regions. The dorsal blood supply accounts for the remaining 70% to 80% and enters the scaphoid through multiple foramina. The reason scaphoid fractures have a hard time healing is due to the anatomy of the blood supply to the bone. The importance of a correct diagnosis and appropriate treatment of scaphoid fractures lies in its blood supply. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The vascularity of the scaphoid bone journal of hand surgery. Pdf examination and treatment of scaphoid fractures and. Although the fracture may heal in as little as six weeks, it may take longer for some. An animated description of the blood supply to the scaphoid and its impact on fracture healing. The blood supply of the scaphoid comes scaphoid fracture is a common injury encountered in family medicine. Scaphoid injuries and prolonged casting these result in missed work days and decreased work efficiency.
Scaphoid fracture is a common injury encountered in family medicine. Volar approach for scaphoid fractures nader paksima, do, mph clinical professor of orthopaedicsurgery nyuhospital for joint diseases internal fixation indicated for displacement 1mm percutaneous fixation recommended only for non. Enter through numerous small foramina along the spiral groove and dorsal ridge. The diagnostic strategy of suspected scaphoid fractures, however, is surrounded by controversy. Then, the fracture will be fixed with a compression screw. The scaphoid is the most commonly fractured carpal bone, accounting for approximately 60% of all carpal fractures. Surgical versus nonsurgical treatment for scaphoid waist. Fractures of the scaphoid bone mainly occur in young adults and constitute 27% of all fractures. The proximal pole depends on blood supply from the distal pole through the scaphoid bone. Acute fractures of the scaphoid northwestern university. This triangular depression is defined by the exten sor and abductors of the thumb, and is easily visible when the wrist is partially ulnar devi ated and the thumb abducted and extended. Scaphoid fractures that do not heal are referred to as a scaphoid nonunion.
Request pdf the blood supply of the scaphoid bone scaphoid vascularisation was investigated using macroscopic and microscopic techniques in 12. Scaphoid fractures can be through the waist, the proximal pole or the tubercle. Second only to the hip in the incidence of avascular necrosis, the scaphoid is extremely susceptible to this disease because of the tenuous blood supply of the scaphoid, which enters the bone through its distal half. 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. Scaphoid fractures can lead to nonunion and avascular necrosis due to interruption of the blood supply.
This is where the blood supply enters the scaphoid bone. This retrograde blood supply is what can cause a fracture nonunion to go on to avn picture 4. The proximal vessel seen in one specimen was of very small caliber and limited penetration. Scaphoid vascularisation was investigated using macroscopic and microscopic techniques in 12 uninjured, formalin fixed cadaver hands. Treatment for a scaphoid fracture can range from casting to surgery, depending on the fractures severity and location on the bone.
The extraosseous and intraosseous blood supply of the. 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. Abstract eleven patients who had an ununited fracture of the scaphoid associated with loss of the blood supply to the proximal fragment were managed operatively with a combination of an inlay corticocancellous bone graft from the iliac crest and implantation of the second dorsal intermetacarpal artery, its accompanying venae comitantes, and a thin cuff of perivascular tissue. The blood supply of the scaphoid has been well documented by gelberman and botte 4. Displaced scaphoid fractures are seen on radiographs. Since blood supply is available from the palmar circulation, a dorsal approach to the scaphoid bone is possible. Due to this perfusion pattern, the scaphoid bone is prone to nonunion after fracture.
Scaphoid waist fractures dorsal approach brandon e. Current methods of diagnosis and treatment of scaphoid. It enters at the distal pole of the bone and runs to its proximal part. When the scaphoid bone is broken, it may not heal properly because it has a very fragile blood supply. Management of suspected scaphoid fracture clear injury and positive exam with normal xrays immobilize for 7 10 days thumb spica best repeat xrays if patient still symptomatic if pain still present but x ray continues to be normal. Due to the vulnerability of the blood supply to the scaphoid, scaphoid fractures have a high risk of nonunion and avascular necrosis with subsequent osteoarthritis. A good blood supply of the scaphoid bone from palmar, dorsal and radial vessel groups with a variety of anastomoses was found which should. Diagnosis and management of scaphoid fractures american. Diagnosis and management of scaphoid fractures aafp. Osteonecrosis of the elbow joint is an often missed diagnosis.
Pdf background about 2 000 patients annually incur a fractured scaphoid in norway. In case of a proximal scaphoid fracture, the blood. The predominant scaphoid blood supply enters the scaphoid distally via the dorsal ridge of the scaphoid, and a fracture of the waist or proximal scaphoid leaves the proximal pole susceptible to avascular necrosis avn given this will disrupt the intraosseous vessels. The main blood supply to the scaphoid is from the radial artery. The blood supply is what keeps the bone alive and allows it to heal. Of these fractures, 40% are undiagnosed at the time of original injury. Scaphoid waist fracture is a common type of wrist fracture, accounting for 51% to 90% of wrist fractures and 2% to 7% of total body fractures. Avascular necrosis of the scaphoid is a common sequela to scaphoid fracture.
Hand anatomy overview bones, blood supply, muscles. The fracture can disrupt the bones blood supply, impairing the healing. Scaphoid blood supply two major vascular pedicles1. Acute fractures of the scaphoid 226 journal of the american academy of orthopaedic surgeons figure 1 a,four views of a right scaphoid demonstrate the complex shape of the scaphoid. Scaphoid fractures may be radiologicallyoccult in the acute setting and may result in. Management for an acute scaphoid fracture begins with a reduction. The major blood supply to the scaphoid is via the radial artery.
The laterovolar and the dorsal systems shared in the supply of the proximal two thirds of the scaphoid, while the distal group remained very see figure in the pdf file much circumscribed to the supply of the tuberosity. Chief of orthopaedicsurgery brigham and womens faulkner hospital vicechair of clinical operations brigham and womens hospital frontiers in upper extremity surgery tampa, florida november 4, 2017 scaphoidwaistfracturesdorsalapproach heard all about the volar approach. Articular surface 75% of scaphoid bone is covered by articular cartilage. Volar branch enters the scaphoid tubercle and supplies its distal 20% to 30%2. The scaphoid receives its blood supply from a nutrient branch of the radial artery. Seventy to eighty percent of the intra osseous vascularity and the entire proximal pole is from. Because of the particular distribution of scaphoid blood vessels, blood circulation is often blocked after fracture of the scaphoid. As the vascular supply to the proximal pole is mainly retrograde, a fracture through the tubercle or the waist places the proximal pole at risk of avascular necrosis. Arterial flow to the scaphoid enters via the distal pole and travels to the proximal pole. Because portions of the scaphoid have a poor blood supplyand a fracture can further disrupt the flow of blood to the bonecomplications with the. The specific blood supply in combination with the demanding functional requirements can easily lead to disturbed fracture healing. Most of the bone is covered with cartilage, the smooth shiny material that forms the joints and allows the bones to move.
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