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CONDITION/DISORDER SYNONYM

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  • Navicular fracture of the hand

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ICD-9-CM CODES1

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  • 814.01 Closed fracture of navicular (scaphoid) bone of wrist

  • 814.11 Open fracture of navicular (scaphoid) bone of wrist

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ICD-10-CM CODES2

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  • S62.009A Unspecified fracture of navicular (scaphoid) bone of unspecified wrist, initial encounter for closed fracture

  • S62.009B Unspecified fracture of navicular (scaphoid) bone of unspecified wrist, initial encounter for open fracture

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PREFERRED PRACTICE PATTERN3

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  • 4G: Impaired Joint Mobility, Muscle Performance, and Range of Motion Associated with Fracture

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PATIENT PRESENTATION

A 25-year-old woman tripped while exiting her tub and fell onto her outstretched hand with her wrist extended. She felt immediate pain, but waited until the next day to seek medical attention. She presented with difficulty moving her wrist in all directions and difficulty gripping objects secondary to worsening pain. She demonstrated mild edema in the wrist and hand. Radiographs showed were negative for a distal scaphoid fracture. Patient was placed in a wrist immobilizer for 3 weeks secondary to pain with a tuning fork and as a precaution. Upon re-examination after 3 weeks patient continued with point tenderness in the snuff box and was sent for a follow-up X-ray. Follow-up X-ray demonstrated a healing fracture line of the scaphoid.

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FIGURE 176-1

Scaphoid fracture in the middle third or waist (arrow). (From Tintinalli JE, Stapczynski JS, John Ma O, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 176-2

Gilula’s arcs are seen shown in this normal patient (A) and in a patient with a scaphoid fracture and perilunate dislocation (B). (From Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz’s Principles of Surgery. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 176-3

A. Preoperative images demonstrate a nonunion of a scaphoid fracture sustained 4 years earlier. B. Postoperatively, cross-sectional imaging with a computed tomography scan in the coronal plan demonstrates bone crossing the previous fracture line. This can be difficult to discern on plain x-rays due to overlap of bone fragments. (From Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz’s Principles of Surgery. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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KEY FEATURES

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Description
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  • Any defect in continuity of the scaphoid (carpal bone)

  • Displaced (scaphoid is moved on either side of the fracture) or nondisplaced (scaphoid has not moved)

  • Closed (skin is intact) or ...

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