Risk of avn depends on the location of the fracture. Article information, pdf download for the blood supply of the scaphoid bone, open. Hand anatomy overview bones, blood supply, muscles geeky. Scaphoid has unique anatomy to its credit when surrounding bones and its arterial supply is considered. Scaphoid blood flow and acute fracture healing semantic scholar.
There is significant intercarpal motion between scaphoid and lunate, which questions the validity of present kinematic models of carpal motion. Scaphoid bone musculoskeletal, skeletal anatomyzone. The scaphoid bone is one of the carpal bones in your hand around the area of your wrist. As such, the scaphoid is perfused in the distal to proximal direction retrograde blood supply. The blood supply of the scaphoid is primarily from the radial artery via the artery to the dorsal ridge of the scaphoid, whose branches enter the scaphoid via. Basic sciences blood supply of the scaphoid youtube. Apr 22, 20 scaphoid blood supply two major vascular pedicles1. The proximal pole depends on blood supply from the distal pole through the scaphoid bone. Diagnosis and management of scaphoid fractures american. The scaphoid receives its primary blood supply from the dorsal scaphoid branches of the radial artery, which enter the scaphoid at a point near the distal pole. Seventy to eight percent of the intraosseous vascularity and the entire.
Nov 23, 2019 this unusual flow of blood in the scaphoid presents a problem when you sustain a scaphoid fracture. In case of a proximal scaphoid fracture, the blood. The scaphoid bone is one of the carpal bones of the wrist. It is important for stability and movement at the wrist and may be fractured after a fall onto a hyperextended hand. Large animal models are the most reliable method to evaluate the efficacy of new treatment modalities before their translation into clinical practice. Request pdf the blood supply of the scaphoid bone scaphoid vascularisation was investigated using macroscopic and microscopic techniques in 12.
Dec 18, 2017 scaphoid fractures can lead to nonunion and avascular necrosis due to interruption of the blood supply. Jfb free fulltext characterization of a preclinical. The waist between the two is the commonest site of scaphoid fracture. This part of the scaphoid bone has a good blood supply, which is necessary for healing. The use of the free vascularised bone graft for nonunion. Scaphoid fractures only account for 2% of all fractures but is second only to femoral head for posttraumatic avn. The scaphoid bone is the largest bone of the proximal row of wrist bones, its long axis being from above downward, lateralward, and forward.
Scaphoid vascularisation was investigated using macroscopic and. The extraosseous and intraosseous blood supply of the scapho. Scaphoid series summary radiology reference article. Over 80% of the bone is covered in articular cartilage. Due to its poor blood supply, healing of a fractured scaphoid can be difficult but is important to wrist function and longterm health.
Ppt scaphoid fractures powerpoint presentation free to. The scaphoid bone, also called the navicular bone, is the largest bone in the proximal row of the wrist, the highly flexible region between the forearm and the hand. There is a rare accessory bone os centrale carpi that can resemble a fracture. A 30yearold man presented with a symptomatic 15yearold right scaphoid fracture with secondary scaphoid nonunion advanced collapse of his right wrist. The scaphoid can be divided into proximal and distal poles. The length of the scaphoid along the baseline is measured, as it the height of the scaphoid perpendicular to the baseline. Since the scaphoid blood supply comes from two different vascular branches of the radial artery, fractures can limit access to blood supply.
When this occurs, healing can be slow, and the scaphoid fracture may not heal at all. The initial injury was from a fall onto his outstretched hand. The flexibility of the wrist can be largely attributed to its unique and complex composition, marked by. It is located on the radial side of the wrist, and articulates with the radius, lunate, trapezoid, trapezium and capitate. No direct blood supply to proximal portion of the bone. This blood supply is easily disrupted, often leaving the proximal. Review of the current methods in the diagnosis and. Imaging and treatment of scaphoid fractures and their. Management of a 15yearold scaphoid nonunion bmj case. The scaphoid also known as the os scaphoideum or historically as the navicular is the largest of the proximal row of carpal bones and forms the radial portion of the carpal tunnel.
Owing to its tenuous blood supply, the scaphoid is particularly susceptible to osteonecrosis and ensuing posttraumatic arthrosis after fracture. The anatomic snuffbox is generally tender and swelling may occur. The scaphoid bone forms part of the wrist joint and interacts with the radius. This method places inductive electromagnetic coils on opposite sides of the fracture site.
Clinical outcome of scaphoid malunion as a result of. Whilst most scaphoid fractures may heal, a number of case series have identified a 10%15% nonunion rate. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Symptoms generally includes pain at the base of the thumb which is worse with use of the hand. Symptoms can include pain and swelling around the wrist. Each chapter covers a different procedure, beginning with a discussion of relevant anatomical. Pdf fractures of the scaphoid, diagnosis and management. This retrograde blood supply is what can cause a fracture nonunion to go on to avn picture 4. Vascular foramina of scaphoid and its clinical implications.
In surgical treatment, holes are drilled and a screw is placed across the fracture to realign the bones and support the site while it heals. Segmental fracture of the scaphoid bmj case reports. A scaphoid fracture is a break of the scaphoid bone in the wrist. Management for an acute scaphoid fracture begins with. For this type of fracture, your doctor may place your forearm and hand in a cast or a splint. A baseline is drawn along the palmar aspect of the scaphoid. This leaves approximately two thirds of patients with no demonstrable fracture. They can disrupt the blood supply to the proximal scaphoid.
A scaphoid fracture is usually caused by a fall on to an outstretched hand. May 22, 20 blood vessels enter through the dorsal ridge and tuberosity. Scaphoid has unique anatomy to its credit when surrounding bones and. The scaphoid fracture first described in 1905 by destot, a french surgeon, anatomist and radiologist, 1 derives its name from the greek word skaphos meaning boat. How to draw the blood supply of the scaphoid, frcs orth revision. Because of the tenuous blood supply, a scaphoid fracture can sever this blood flow and stop the delivery of necessary oxygen and nutrients to the bone cells. Scaphoid fractures can lead to nonunion and avascular necrosis due to interruption of the blood supply. The heightlength ratio was estimated on the central longitudinal ct slice. Like the scaphoid bone of the wrist, the elbow joint is extremely susceptible to this disease because of the tenuous blood supply of the articular cartilage. Featuring insights from pioneers in the field, its comprehensive coverage extends from standard open procedures to stateoftheart percutaneous methods and miniincision techniques. Scaphoid fractures may be radiologicallyoccult in the acute setting and may result in. Avascular necrosis avn is a common complication of a scaphoid fracture. Scaphoid fracture causes, symptoms, diagnosis, and treatment. In case of a proximal scaphoid fracture, the blood supply through the scaphoid bone is interrupted, making.
Osteonecrosis is said to occur in %50% of cases of fracture of the scaphoid, and the incidence of osteonecrosis is even higher in those with involvement of the proximal onefifth of the scaphoid. Delayed union, malunion, or nonunion are often associated with fractures that are inadequately immobilized. Scaphoid links the proximal and the distal carpal rows. The scaphoid tubercle is a bony prominence on the ventral surface of the lateral portion of the distal pole. For more information, you can read a more indepth reference article. Fractures in the proximal have a high incidence of avn 30%. Blood flow to the scaphoid bone occurs via retrograde backwards flow, meaning blood enters at the distal top portion of the bone and there is no direct blood supply to the proximal bottom portion of the bone. Waldman md, jd, in atlas of uncommon pain syndromes third edition, 2014. This blood supply is easily disrupted, often leaving the proximal portion of the bone without nutrition and leading to osteonecrosis figure 401.
The scaphoid blood supply comes from the dorsal branch of the radial artery coursing retrograde proximal 80% of scaphoid and superficial palmar arch distal 20% of scaphoid. Scaphoid fractures that are closer to the thumb distal pole usually heal in a matter of weeks with proper protection and restricted activity. However, they are most commonly used in the assessment of trauma, by clinical teams within the emergency department or orthopedic service. The blood supply of the scaphoid comes scaphoid fracture is a common injury encountered in family medicine. The vascularity of the scaphoid bone sciencedirect. Current methods of diagnosis and treatment of scaphoid fractures. Osteonecrosis of the elbow joint is an often missed diagnosis. An animated description of the blood supply to the scaphoid and its impact on fracture healing. Scaphoid fractures usually result from wrist hyperextension, typically during a fall on an outstretched hand. To avoid missing this diagnosis, a high index of suspicion and a thorough history and. Scaphoid fractures and blood supply nabil ebraheim medium.
Careful preoperative planning is therefore essential. The extraosseous and intraosseous blood supplies of the scaphoid were determined in eleven human spe. Normal scaphoid anatomy slide 1 and blood supply slide 2 mechanism of injury and classification of scaphoid fractures slide 3 and their complications nonunion, osteonecrosis, snac wrist imaging of scaphoid fractures including radiography, mri, ct, ultrasonography, and bone scan. Fractures of the scaphoid are well known to be problematic especially when complicated by avascular necrosis, nonunion and carpal collapse. A good blood supply of the scaphoid bone from palmar, dorsal. Seventy to eighty percent of the intraosseous vascularity and the entire proximal pole is from.
The scaphoid receives its blood supply from a nutrient branch of the radial artery. Volar approach to the scaphoid orthopaedicsone articles. The scaphoid is the most commonly fractured carpal bone accounting for 60% of fractures 1, 2. Scaphoid blood supply two major vascular pedicles1. Treatment of nonunited scaphoid fractures by pulsed. It is the most common carpal bone to break fracture. Scaphoid fractures musculoskeletal medicine for medical. Since blood supply is available from the palmar circulation, a dorsal approach to the scaphoid bone is possible. A fracture of the scaphoid which can result from a fall onto an outstretched hand can, therefore, lead to avascular necrosis of the proximal bony fragment. In scaphoid fracturesespecially those in which the bone fragments have become displacedthe blood supply to the bone may be disrupted. Enter through numerous small foramina along the spiral groove and dorsal ridge.
Scaphoid vascularisation was investigated using macroscopic and microscopic techniques in 12 uninjured, formalin fixed cadaver hands. A good blood supply of the scaphoid bone from palmar, dorsal and radial vessel groups with a variety of anastomoses was found which should. Management for an acute scaphoid fracture begins with a reduction. The prevalence of scaphoid fracture ranges from 19, and other fractures collectively from19 to 24. Complications may include nonunion of the fracture, avascular necrosis, and arthritis scaphoid fractures are most commonly caused by a fall on an outstretched hand. The scaphoid brings together in one definitive reference every aspect of carpal scaphoid injury treatment. Management of a 15yearold scaphoid nonunion bmj case reports. The use of the free vascularised bone graft for nonunion of. Most of the blood supply derives from branches of the radial artery that penetrate the scaphoid distally and supply 70%80% of the more proximal bone, thus giving rise to the problem of a higher rate of nonunion and avascular necrosis in more proximal fractures. The extraosseous and intraosseous vascularity of the carpal scaphoid was studied in 15 fresh cadaver specimens by injection and clearing techniques. The diagnostic strategy of suspected scaphoid fractures, however, is surrounded by controversy. The scaphoid does not have any tendinous attachments.
Blood vessels enter through the dorsal ridge and tuberosity. Volar branch enters the scaphoid tubercle and supplies its distal 20% to 30%2. The specific blood supply in combination with the demanding functional requirements can easily lead to disturbed fracture healing. Review of the current methods in the diagnosis and treatment. The palmar approach further runs the risk of devascularising the proximal part of the scaphoid because the main blood supply that comes in through the dorsum is not visualised. Rule of 70s for scaphoid 70% of all carpal fractures occur at scaphoid. The palmar surface of the scaphoid is concave, and forming a tubercle, giving attachment. Clinical outcome of scaphoid malunion as a result of scaphoid. The distal pole is supplied by both the palmar scaphoid branch of the superficial palmar branch of. Displaced scaphoid fractures are seen on radiographs.
Hand anatomy overview bones, blood supply, muscles. The scaphoid is situated between the proximal and distal rows of carpal bones. Nonunion is directly related to an interruption of the tenuous blood supply to the scaphoid. Osteonecrosis is said to occur in %50% of cases of fracture of the scaphoid, and the incidence of osteonecrosis is even higher in those with involvement of the proximal one. Osteonecrosis is thus a common complication, even when initial care is optimal, and can cause disabling, degenerative arthritis of. The scaphoid bone is one of eight small bones that make up the carpal bones of the wrist. Sep 23, 2016 so, there is a risk that if you have a fracture in this area, it can sometimes stop the blood supply to part of the scaphoid bone, leaving part of the bone without a blood supply. Fixation techniques have involved nonvascularised bone grafting. May 10, 2015 rule of 70s for scaphoid 70% of all carpal fractures occur at scaphoid. Fractures of the scaphoid bone mainly occur in young adults and constitute 27% of all fractures. A good blood supply of the scaphoid bone from palmar, dorsal and radial vessel groups with a variety of anastomoses was found which should provide sufficient collateral blood flow from adjacent regions in some patients. Dec 08, 2016 how to draw the blood supply of the scaphoid, frcs orth revision.
The major blood supply to the scaphoid is via the radial artery. This limited arterial supply to the proximal portion, is clinically significant in scaphoid fractures which are very common injuries following a fall on an outstretched hand and can result in avascular necrosis of the proximal segment, or other complications such as nonunionmalunion. Scaphoid fractures musculoskeletal medicine for medical students. Scaphoid fractures account for 50%80% of carpal bone fractures in young adults. A scaphoid series or scaphoid xray may be performed for a multitude of reasons. Avoids damaging the dorsal blood supply to the bones proximal half. Mar 19, 2015 an animated description of the blood supply to the scaphoid and its impact on fracture healing. These coils supply a 15 hz pulsed quasirectangular electrical signal. Scaphoid nonunion affects wrist joint function and is often associated with a predictable pattern of degenerative change. May 1986 nonunited scaphoid fractures treated by pemf and cast 345 fig. The treatment of nonunion remains challenging because of the scaphoids small size and delicate blood supply.
A fractured scaphoid is a common disabling injury that is frequently complicated by nonunion. It enters at the distal pole of the bone and runs to its proximal part. It is situated between the hand and forearm on the thumb side of the wrist also called the lateral or radial side. Current methods of diagnosis and treatment of scaphoid.
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