hand
Scaphoid Fracture
advanced
6 min
28 marks
6 questions
Clinical Scenario
A 24-year-old male motorcyclist presents after a fall onto his outstretched right (dominant) hand. He has pain and swelling on the radial side of the wrist. On examination, there is tenderness in the anatomical snuffbox and over the scaphoid tubercle. Axial loading of the thumb reproduces pain. Wrist movements are restricted by pain. Standard wrist X-rays appear normal but a scaphoid view shows a minimally displaced waist fracture.
PA wrist radiograph with scaphoid (ulnar deviation) view demonstrating a displaced scaphoid waist fracture. There is >1mm displacement and >15° humpback deformity. The fracture line is clearly visible across the waist. No secondary arthritis is present. This fracture pattern has increased non-union risk and requires surgical fixation with headless compression screw.
Source: AI-Generated: Educational Radiograph of Displaced Scaphoid Waist Fracture • OrthoVellum AI • OrthoVellum Educational Use
Questions
Question 1 (4 marks)
Describe the anatomy of the scaphoid including blood supply and implications.
Question 2 (5 marks)
Classify scaphoid fractures and describe imaging requirements.
Question 3 (6 marks)
What is the treatment algorithm for acute scaphoid fractures?
Question 4 (5 marks)
Describe surgical technique for headless screw fixation.
Question 5 (4 marks)
What are the risk factors for non-union and how do you manage it?
Question 6 (4 marks)
What is SNAC wrist and how is it managed?
Exam Day Cheat Sheet
Must Mention
- •Blood supply: distal to proximal (dorsal 80%, volar 20%)
- •Proximal pole highest AVN risk
- •Displacement >1mm = surgery
- •Herbert classification (A stable, B unstable)
- •Waist 70%, proximal 20%, distal 10%
- •SNAC stages I-IV with treatment
Common Pitfalls
- •Wrong blood supply direction
- •Missing displacement threshold
- •Wrong Herbert types
- •Not knowing SNAC stages
- •Missing vascularized graft
- •Confusing SNAC/SLAC