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Scaphoid Fracture, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • The scaphoid is the most commonly fractured carpal bone.

  • This bone is the stabilizer between the distal and proximal carpal rows.

  • Injury may result in arthritis, avascular necrosis, or...

Diagnosis

Signs and Symptoms

History

FOOSH injury 

Physical Exam

  • Maximal pain and tenderness in the anatomic snuffbox (may be elicited with direct palpation or axial loading of the thumb); 90% sensitive, ...

Treatment

Pre-Hospital

Splint or immobilize as appropriate. 

Initial Stabilization/Therapy

  • Evaluate patient for other injuries.

  • Dress open wounds.

  • Immobilize with thumb in neutral position, ice, and elevat...

Follow-Up

Disposition

Admission Criteria

Open fracture or presence of other more serious injuries 

Discharge Criteria

  • Closed injuries, with 72-hr orthopedic follow-up

  • Patients with splints for nondisplaced...

Pearls and Pitfalls

  • Perfusion enters scaphoid bone distally.

  • Avascular necrosis (especially with proximal 3rd fractures), occurs with inadequately reduced or immobilized fractures.

  • Patients presenting w...

Additional Reading

  • Chudnofsky  CR, Byers  SE. Clinical Procedures in Emergency Medicine: Splinting Techniques. 5th ed. Philadelphia, PA: Saunders Elsevier; 2010.

  • Kumar  S, O’Connor  A, Despois  M, et...

Codes

ICD9

814.01 Closed fracture of navicular [scaphoid] bone of wrist 

ICD10

  • S62.009A Unsp fracture of navicular bone of unsp wrist, init

  • S62.026A Nondisp fx of middle third of navic bone of unsp wrist,...

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