Update on Management of Scaphoid Fractures | Journal CME Article-Article

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Scaphoid fractures present significant challenges due to the bone's unique anatomy and complex biomechanics. These fractures, which account for 60% of all carpal fractures, are prone to complications like avascular necrosis (AVN) and require careful treatment to avoid long-term wrist dysfunction or early-onset osteoarthritis. Predominantly affecting young adult males, scaphoid fractures often result from falls onto outstretched hands during sports or motor vehicle accidents, with a notably high incidence in male military personnel.<br /><br />The scaphoid’s blood supply primarily comes from the radial artery, creating a risk for AVN, especially with fractures in the proximal pole. Diagnosing a scaphoid fracture involves thorough clinical evaluation and appropriate imaging—generally starting with X-rays, though CT and MRI may be necessary for suspected occult fractures or displaced fractures. Advanced imaging technologies can confirm fractures that initial X-rays miss and inform appropriate treatment decisions.<br /><br />Treatment depends on fracture stability, location, and displacement. Nondisplaced fractures often heal with cast immobilization, but displaced or unstable fractures typically require surgical intervention. Techniques include open or percutaneous fixation, sometimes supplemented with bone grafts. Surgical intervention is also preferred in high-performance athletes to minimize downtime and expedited return to function, although it comes with potential complications.<br /><br />Nonunion, in which a fracture doesn’t heal within six months, presents additional treatment challenges, especially with proximal pole involvement or high AVN risk. Solutions include surgical fixations, potentially using vascularized bone grafts to encourage healing and stabilize the bone.<br /><br />Overall, successful treatment of scaphoid fractures necessitates a thorough understanding of the bone’s anatomy, early and accurate diagnosis, and careful consideration of each patient’s specific circumstances. Advances in surgical techniques and imaging continue to improve outcomes for those affected by these challenging injuries.

Keywords

scaphoid fractures

avascular necrosis

carpal fractures

radial artery

imaging technologies

surgical intervention

bone grafts

nonunion

proximal pole

young adult males