2. Derived from greek word ‘scaphos’ meaning boat
Boat or cashew shaped bone
Rule of 70 for scaphoid –
Accounts for 70% of carpal fractures
Of these 70% occur at waist
70% of scaphoid fractures unite
70% of vascular supply is through dorsal branch of
radial artery
3. Boat or cashew shaped
80% of bone covered by articular surface expect
tubercle
Located in a 45° plane to horizontal
and vertical axes
•
4.
5.
6.
7.
8. Common in young adults
Fall on outstretched hand
Mechanism – Bending with
compression dorsally and tension
on palmar surface owing to forced
dorsiflexion
9. Proper history about mechanism of injury
Clinical examination
Radiographic evaluation –
X-ray – PA view, lateral, Radial oblique, ulnar
oblique, Scaphoid view
MRI – 100% sensitivity even in 48 hrs
Tc 99 bone scans also have high sensitivity in occult
fractures
10.
11.
12.
13. 80 %
15%
5%
Time to union – 4-6
weeks
Time to union – 10-
12 weeks
Time to union – 12-
20 weeks
14. Type A
Stable Acute fracture
A1 : Fracture through tuberosity
A2 : Incomplete fracture through waist
HERBERT AND FISHER
CLASSIFICATION
15. Type B
Unstable Acute Fractures
Type B1: Distal Oblique Fracture
Type B2: Complete Fracture of Waist
Type B3: Proximal Pole Fracture
Type B4: Transscaphoid-
Perilunate
Fracture-Dislocation
of Carpus
Type B5: Comminuted
Fractures
16. Type C Delayed Union
Type D
Established Nonunuion
Type D1: Fibrous Union
Type D2: Pseudarthrosis
17.
18. Type 1 – Tuberosity
fracture
Type 2 - Distal intra-
articular fracture
Type 3 –
Osteochondral
fracture
19. Occult Fractures – Colles cast for 4-6 weeks
Type A1 – Colles cast cast for 4-6 weeks
Type A2 – Below elbow cast in neutral position cast c
ast for 6-12 weeks in low demand patients
in other patients percutaneous screw fixation
A displaced fracture is defined as one with more than 1 mm of step-off or more than
60 degrees of SL or 15 degrees of lunato-capitate angulation as observed on
either plain radiographs or CT scans.
21. Type B2 – Percutaneous screw fixation
- in case reduction cannot be achieved, open
reduction and internal fixation
- Cast required in case of asso. ligamentous injury
In case of hump-back deformity, bone-grafting may be
required
Hump-back deformity
22. Type B3 - closed or open reduction and screw fixation
through dorsal approach
31. Type D1 – Open reduction and screw fixation with
bone gafting- either from distal radius or iliac crest
Success – 60-95%
Type D2 – Open reduction and internal fixation with
bone graft or vascularised bone graft – pronator
quadratus
