Name that fracture, ideal imaging modality, and treatment including indication for operative repair:

IMG_2717

That would be a classic scaphoid fracture. It should ideally be imaged first with a three-view x-ray (AP, lateral, and scaphoid view – 30 deg extension, 20 deg ulnar deviation), but an MRI is the most sensitive for occult fractures. CT with 1 mm cuts is also acceptable although less sensitive than MRI.

Treatment is typically non-operative with thumb spica cast immobilization. Over 90% of fractures can be managed this way. Indications for operative repair include: proximal pole fractures, displacement > 1 mm, 15 deg scaphoid humpback deformity, radiolunate angle > 15 deg, intra-scaphoid angle of 35 deg, comminuted fractures, unstable vertical / oblique fractures, and any fracture associated with a perilunate dislocation. Duration of casting varies from 3-5 months depending on location of the fracture. Importantly, don’t forget to cast / splint any suspected fracture and refer for prompt follow up for reimaging.

The only question that remains unanswered is how did Matt Egan’s scaphoid become so jacked up…

References:

Abbasi, David, Scaphoid Fracture. http://www.orthobullets.com/hand/6034/scaphoid-fracture.

deWeber, Kevin. Scaphoid fractures. Uptodate. Eiff P. Grayzel, J (eds). http://www.uptodate.com/contents/scaphoid-fractures

Egan, Matt, Scaphoid image