Scaphoid Fracture


Most common carpal fracture

MECHANISM

DIAGNOSIS

TREATMENT

Adults

  Initial Treatment
Splint type & position Suspected: short-arm thumb spica cast or splint
Non-displaced:
  Distal third -- short-arm thumb spica cast or splint (slight wrist extension)
  Middle or proximal -- Long-arm thumb spica cast or splint (slight wrist extension)
Initial follow-up visit Suspected: 2 weeks
Non-displaced: 1 to 2 weeks
Pt instructions Icing and elevation for 24 to 48 hours
Maintain finger and shoulder ROM
  Follow-up Care
Cast or Splint type & position Suspected: short-arm thumb spica cast
Nondisplaced:
 Distal third -- Short-arm thumb spica cast
 Middle or Proximal -- long-arm thumb spica cast for 6 weeks; then short-arm thumb spica cast for remaining weeks
Length of immobilization Suspected: continue until diagnosis confirmed
Non-displaced:
 Distal -- 4 to 6 weeks
 Middle -- 10 to 12 weeks
 Proximal -- 12 to 20 weeks
Healing time Distal: 6 to 8 weeks
Middle: 12 to 14 weeks
Proximal: 18 to 24 weeks
Follow-up visit interval Suspected: every 2 weeks until diagnosis confirmed
Non-displaced: every 2 to 3 weeks until radiographic union
Repeat radiography interval Suspected: every 2 weeks until diagnosis confirmed
Bone scan at 2 or 4 weeks from date of injury if plain films still show no abnormalities
Non-displaced: every 2 to 3 weeks until radiographic union
Pt instruction Maintain finger, elbow, and shoulder ROM during immobilization
Indications for orthopedic consult Consider for non-displaced fractures because of high risk for poor healing
Displaced fractures
Nonunion
Early signs of AVN

Pediatric

  Initial Treatment
Splint type & position Suspected: Short-arm thumb spica cast or splint
Non-displaced:
 Avulsion or distal third = Short-arm thumb spica cast
 Middle third = Long-arm thumb spica cast
Wrist in slight flexion, slight radial deviation, leave thumb IP joint free
Initial follow-up visit Suspected: 10 to 14 days
Non-displaced: 1 to 2 weeks
Pt instructions Icing and elevation for 24 to 48 hours
Maintain finger and shoulder ROM
  Follow-up Care
Cast or Splint type & position Suspected: short-arm thumb spica cast
Nondisplaced:
 Distal third -- Short-arm thumb spica cast
 Middle or Proximal -- long-arm thumb spica cast for 6 weeks; then short-arm thumb spica cast for remaining weeks
Length of immobilization Suspected: continue until diagnosis confirmed
Non-displaced:
 Avulsion or distal -- 4 to 6 weeks
 Middle -- 6 to 8 weeks
Healing time Avulsion or distal third: 6 to 8 weeks
Middle third: 8 to 12 weeks
Follow-up visit interval Suspected: every 2 weeks until diagnosis confirmed
Non-displaced: every 2 to 3 weeks until radiographic union
Repeat radiography interval Suspected: every 2 weeks until diagnosis confirmed
Bone scan at 2 or 4 weeks from date of injury if plain films still show no abnormalities
Non-displaced: every 2 to 3 weeks until radiographic union
Pt instruction Maintain finger, elbow, and shoulder ROM during immobilization
Indications for orthopedic consult Proximal pole fractures
Displaced fractures
Associated carpal fractures

COMPLICATIONS

Return to Work or Sports