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The first 25 slides, exactly as they appear. The full deck has 70 content slides.
Orthopaedics
Fractures of the Scaphoid
Built from Tang — Orthopaedic Trauma Vol 1: Upper Extremity
What’s inside
6 sections · 70 slides
Overview
- What this deck covers
Foundations
Why the scaphoid's anatomy makes it fracture badly and heal slowly
- Meet the scaphoid
- Scaphoid fractures by the numbers
- Who and how often
- Most of the scaphoid is cartilage, not bone surface
- Three parts, five joints
- The key idea: a retrograde blood supply
- Blood vessels enter along the dorsal ridge
- Angiogram of the scaphoid's vessels
- Two vascular groups feed the bone
- Why the proximal pole is so vulnerable
- Dense ends, sparse middle: the trabecular pattern
- A mechanically weak waist
- Ligament tension shifts as the wrist moves
How it breaks and how we name it
Mechanism of injury and the main classification systems
- Mechanism of injury
- The fall-on-outstretched-hand mechanism
- Two everyday ways to classify
- Fracture patterns grouped by location
- By stability - who needs surgery
- The Herbert classification (1)
- The Herbert classification (2)
- Herbert classification at a glance
- The Herbert classification illustrated
Making the diagnosis
Why a normal X-ray does not rule it out - and what does
- Clinical assessment: look at the snuffbox
- Where and how to examine the scaphoid
- Three clinical signs: very sensitive, not specific
- Reading those three signs
- Imaging: three tools, different jobs
- Getting the most out of X-ray
- The four standard wrist X-ray views
- A dedicated scaphoid view showing the fracture clearly
- The same bone with the fracture hidden by overlap
- Positioning the wrist for a scaphoid view
- When to reach for CT
- X-ray looks aligned, but CT shows displacement
- MRI and other tests
- MRI revealing bone death after fracture
Surgical treatment
From a percutaneous screw to bone grafting a nonunion
- Who is treated how
- Choosing the approach: protect the blood supply
- Blood supply guides the volar and dorsal approaches
- Percutaneous cannulated screw: the idea
- The trade-off of going percutaneous
- Needle entry at the distal scaphoid
- Placing the guide wires
- Guide wires along the scaphoid's axis
- Guide-wire placement during surgery
- Getting the screw length right
- Determining length and countersinking the screw
- X-rays after a percutaneous headless screw
- Where exactly should the screw sit
- Open reduction: the Russe approach
- The extended Russe approach for open reduction
The fracture that never healed
Managing scaphoid nonunion
- Nonunion: the numbers and the decision
- Tailoring treatment to the patient
- Russe bone grafting, step by step
- Getting the graft and fixation right
- Other surgical options
- Complications: necrosis and nonunion
- Complications: nerve and tendon injury
- Complications: arthritis and instability
- Key takeaways
- Why is a proximal-pole scaphoid fracture so much more dangerous than a distal (tubercle) fracture?
- References
- Orthopaedic Trauma Surgery - Volume 1: Upper Extremity