Scaphoid fractures are the most common carpal fractures, about which debate continues. There is a number of unanswered questions, concerning such issues as scaphoid vascularity, anatomy, clinical and radiological diagnosis, and treatment options.
The blood supply of the scaphoid is derived from two sources. The main source is a group of vessels entering the dorsal surface of the distal pole. This is the largest contribution to the vascularity of the scaphoid. For this reason, the proximal pole relies on a retrograde blood flow. A second group of vessels enters the palmar aspect of the distal pole. These vessels contribute to a lesser degree to the vascularity of the distal third of the scaphoid.
The clinical signs of this fracture are swelling and pain in the scaphoid region, tenderness in the “anatomical snuffbox”, pain on axial compression (by the clinical compression test, as shown in this image), pain while pronating the hand, and painful pinch grip. Another problem is that many patients seek medical care late, because they have only minimal symptoms.
Radiological diagnosis consists of a scaphoid series of x-rays: AP, lateral, semipronated and semisupinated views. In cases of so-called “occult” fractures, the fracture is not visible on the radiographs. In such cases, if the clinical signs are highly suggestive of fracture, a 2 week period of cast immobilization is recommended, followed by a repeat x-ray series. Other options are MRI, or CT scan, if available.