- Kevin deWeber, MD, FAAFP, FACSM
Kevin deWeber, MD, FAAFP, FACSM
- Family Medicine of SW Washington Residency
- PeaceHealth SW Medical Center
- Affiliate Associate Professor of Family Medicine
- Oregon Health and Science University
- Clinical Instructor of Family Medicine
- University of Washington School of Medicine
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
Scaphoid fractures are among the most common upper extremity injuries. They frequently occur following a fall onto an outstretched hand. Plain radiographs taken soon after the injury may not reveal a fracture, but the clinician should assume one is present until definitive proof otherwise is obtained.
This topic will review the diagnosis and nonoperative management of scaphoid (navicular) fractures in adults. An overview of carpal fractures and distal radius fractures and discussions of how to evaluate wrist or thumb pain in adults are presented separately. (See "Overview of carpal fractures" and "Evaluation of the adult with acute wrist pain" and "Evaluation of the adult with subacute or chronic wrist pain" and "Evaluation of the patient with thumb pain" and "Distal radius fractures in adults" and "Anatomy and basic biomechanics of the wrist".)
Carpal fractures account for approximately 5 percent of all fractures and 18 percent of hand fractures, and scaphoid fractures are the most common carpal fracture [1-3]. Scaphoid fractures account for 10 percent of all hand fractures and 60 to 70 percent of all carpal fractures [1,4].
A study of scaphoid fractures in the military showed an unadjusted incidence of 1.21/1000 person-years. In addition, males and whites had a higher relative risk, and 20 to 24 year olds had the highest incidence at 1.64/1000 person-years . According to data from the United States National Electronic Injury Surveillance System, the estimated incidence in the population at large is 1.47 fractures/100,000 person-years .
The anatomy and biomechanics of the wrist are discussed in detail separately; anatomy of particular relevance to scaphoid injury is reviewed here. (See "Anatomy and basic biomechanics of the wrist".)
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- Karl JW, Swart E, Strauch RJ. Diagnosis of Occult Scaphoid Fractures: A Cost-Effectiveness Analysis. J Bone Joint Surg Am 2015; 97:1860.
- Yin ZG, Zhang JB, Gong KT. Cost-Effectiveness of Diagnostic Strategies for Suspected Scaphoid Fractures. J Orthop Trauma 2015; 29:e245.
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- Singh HP, Taub N, Dias JJ. Management of displaced fractures of the waist of the scaphoid: meta-analyses of comparative studies. Injury 2012; 43:933.
- Bond CD, Shin AY, McBride MT, Dao KD. Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures. J Bone Joint Surg Am 2001; 83-A:483.
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- Dias JJ, Dhukaram V, Abhinav A, et al. Clinical and radiological outcome of cast immobilisation versus surgical treatment of acute scaphoid fractures at a mean follow-up of 93 months. J Bone Joint Surg Br 2008; 90:899.
- Vinnars B, Pietreanu M, Bodestedt A, et al. Nonoperative compared with operative treatment of acute scaphoid fractures. A randomized clinical trial. J Bone Joint Surg Am 2008; 90:1176.
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- Buijze GA, Goslings JC, Rhemrev SJ, et al. Cast immobilization with and without immobilization of the thumb for nondisplaced and minimally displaced scaphoid waist fractures: a multicenter, randomized, controlled trial. J Hand Surg Am 2014; 39:621.
- Clay NR, Dias JJ, Costigan PS, et al. Need the thumb be immobilised in scaphoid fractures? A randomised prospective trial. J Bone Joint Surg Br 1991; 73:828.
- Doornberg JN, Buijze GA, Ham SJ, et al. Nonoperative treatment for acute scaphoid fractures: a systematic review and meta-analysis of randomized controlled trials. J Trauma 2011; 71:1073.
- Gellman H, Caputo RJ, Carter V, et al. Comparison of short and long thumb-spica casts for non-displaced fractures of the carpal scaphoid. J Bone Joint Surg Am 1989; 71:354.
- CLINICAL ANATOMY
- MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- DIAGNOSTIC IMAGING
- MANAGEMENT OF SUSPECTED ACUTE FRACTURE WITH NEGATIVE PLAIN RADIOGRAPHS
- Approach to imaging and diagnosis
- Magnetic resonance imaging
- Radionuclide bone scan
- Computed tomography
- DIFFERENTIAL DIAGNOSIS
- INDICATIONS FOR SURGICAL REFERRAL
- IMMOBILIZATION (CASTING) AND GENERAL MANAGEMENT
- Initial treatment
- Casting recommendations
- FOLLOW-UP CARE
- RETURN TO SPORT OR WORK
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS