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  • Navicular fracture of the hand

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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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  • 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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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 open (skin is breached)

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Essentials of Diagnosis

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  • Diagnosis is usually made by clinical examination
  • May not be a fracture but a wrist sprain, Colles’ fracture, distal radioulnar subluxation/dislocation, or fracture of any other carpal bone

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General Considerations

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  • Most frequently fractured carpal bone (71% of all carpal bone fractures)

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Demographics

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  • Occurs in young and middle-aged adults 15 to 60 years of age
  • Men aged 20 to 30 years are most likely to suffer from a scaphoid fracture

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Signs and Symptoms

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  • Pain at the base of the thumb
  • Point tenderness within the snuff box
  • Edema
  • Loss of general function
  • Loss of active wrist and/or thumb mobility
  • Muscle guarding with passive movement

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Functional Implications

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  • Pain with weight-bearing activities on involved hand
  • Pain with wrist and thumb movements (passive or active)
  • Pain when gripping something

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Possible Contributing Causes

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  • Mechanism of injury
    • Fall on outstretched hand
    • Direct impact (i.e. athletic activity, motor vehicle accident)

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Differential Diagnosis

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  • Colles’ fracture
  • Distal radioulnar subluxation/dislocation
  • Wrist sprain

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Imaging

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  • X-ray for fracture, often limited view
  • Computed tomography (CT) scan for detailed imaging
  • MRI

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  • Pain with passive/active ROM of the wrist and thumb
  • Wrist will often be held in radial deviation
  • Muscle guarding with all movements
  • Inability to actively perform wrist or thumb movements secondary to pain
  • Pain with gripping activities

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  • For imaging, x-ray or CT
  • For medication: NSAID or opiod for pain management
  • For immediate orthopedic consult:
    • Distal scaphoid pole fractures are treated non-operatively
      • Immobilization casting of hand and may or may not include thumb
    • Waist or proximal scaphoid pole fractures may be treated:
      • Non-operatively, Immobilization cast of hand and thumb
      • Operatively, open reduction internal fixation

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  • Inability to perform activities of daily living with involved hand
  • Inability to bear weight on involved hand
  • Inability to use involved hand to write (especially if it is patient’s dominant hand)
  • Inability to grab a cup or open a door secondary to pain and muscle weakness

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  • Address swelling
    • Ice/cryotherapy
    • Compression
    • ...

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