Outlines current management of upper limb conditions in primary care settings
This information is for primary care physicians and a general summary of current practice
Please consult a physician directly for management of specific injuries
Scaphoid Fracture Immobilisation
MOI: Fall on outstretched hand
Differential Diagnosis: Wrist "sprain"
Management: short arm, circumferential, wrist immobilisation +/- thumb MPJ
Diagnosis
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tenderness with snuff box and/or volar scaphoid palpation
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pain with axial loading
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may or may not have pain with range of movement
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oedema through the wrist, specifically radial wrist
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X-ray imagining - scaphoid fracture may not present on the initial x-ray
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if you suspect an acute scaphoid fracture but it does not show on x-ray, a second x-ray 10-14 days post-injury is recommended. A ULQ specialist can facilitate this
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MRI can be a cost effective way to diagnose scaphoid fractures and save patients from being immobilised unnecessarily for 10-14 days
Scaphoid Vascular Supply
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Primarily through the radial artery
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Proximal scaphoid is supplied through retrograde flow by the dorsal carpal branch (80%)
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Distal Tuberosity is supplied by the superficial palmar arch (20%)
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The limited blood supply through the proximal scaphoid increases the risk of poor fracture healing
Immobilisation
Thumb or no thumb?
Literature suggests that thumb MP joint range of movement does not impact scaphoid fractures
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Short arm, circumferential, wrist immobilisation orthosis
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Wrist in slight extension (approx. 20°)
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The 1st MP joint does not need to be included (thumb MP joint), but may be included for pain management or for active patients
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Finger MCPJ's free to allow full range of movement
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Advise patient no heavy lifting, gripping, pushing or pulling
