Wrist and hand

Scaphoid fracture

Mechanism: A fall on the outstretched hand with the wrist in dorsiflexion. The blood supply of the scaphoid runs from distal to proximal, so a fracture in the middle or proximally cuts off the upper part from its supply.
Recognition: Tenderness in the anatomical snuffbox, on the scaphoid tuberosity, and pain on axial compression of the thumb. The three together are far more specific than each alone.
Course: The fracture is often invisible on the first radiograph. With tenderness and a negative film the suspicion stands: immobilise and reassess after ten to fourteen days. A missed scaphoid fracture ends in a non-union with subsequent wrist osteoarthritis.

Structures