Scaphoid

Blood supply

• Proximal pole: Dorsal br of Radial a (retrograde)
  • more chance of AVN
• Distal pole: Volar br

Displaced

• 1mm

• 10 degree angulation

• SL angle >45
• CL angle >15

Suspected fracture

• SAC for 2 weeks
• clinical and X-ray assessment
• if suspecious: MRI
  • Bone scan less specific (80%) 97% sensitive
  • CT (95% sen and sp)
  • MRI (99 % specific) 96% sensitive
  • X ray (70% sensitive)

Undisplaced

• 8 weeks SAC
• Painful at 8 weeks: 4 more weeks and leave alone
• Needs followup upto 6 month for ruling out non union

Displaced

• Waist: Volar
• Prox pole: Dorsal between 3 and 4 compartment

Nonunion

• Unstable #
• prox pole
• Smoking
• Delayed treatment
• Delated diagnosis

Gray algorithm

• Displaced/AVN: vascularised BG and IF
• Non displaced and no AVN: non vascularised BG
• Diagnosis
  • Gad MRI
  • Punctate bleeding at surgery: Gold standard

SNAC

• 1: Scapho radial styloid arthritis
• 2: entire scaphoid fossa involved
• 3: Scaphocapitate
• 4: Pan scaphoid

Treatment

• 1: Radial styloidectomy
• 2,3: Scaphoid excision and PRC (old) /4Corner fusion (young)
• 4: wrist arthrodesis