Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Navicular fracture of the hand ++ 814.01 Closed fracture of navicular (scaphoid) bone of wrist814.11 Open fracture of navicular (scaphoid) bone of wrist ++ S62.009A Unspecified fracture of navicular (scaphoid) bone of unspecified wrist, initial encounter for closed fractureS62.009B Unspecified fracture of navicular (scaphoid) bone of unspecified wrist, initial encounter for open fracture ++ 4G: Impaired Joint Mobility, Muscle Performance, and Range of Motion Associated With Fracture +++ Description ++ 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) +++ Essentials of Diagnosis ++ Diagnosis is usually made by clinical examinationMay not be a fracture but a wrist sprain, Colles’ fracture, distal radioulnar subluxation/dislocation, or fracture of any other carpal bone +++ General Considerations ++ Most frequently fractured carpal bone (71% of all carpal bone fractures) +++ Demographics ++ Occurs in young and middle-aged adults 15 to 60 years of ageMen aged 20 to 30 years are most likely to suffer from a scaphoid fracture +++ Signs and Symptoms ++ Pain at the base of the thumbPoint tenderness within the snuff boxEdemaLoss of general functionLoss of active wrist and/or thumb mobilityMuscle guarding with passive movement +++ Functional Implications ++ Pain with weight-bearing activities on involved handPain with wrist and thumb movements (passive or active)Pain when gripping something +++ Possible Contributing Causes ++ Mechanism of injuryFall on outstretched hand Direct impact (i.e. athletic activity, motor vehicle accident) +++ Differential Diagnosis ++ Colles’ fractureDistal radioulnar subluxation/dislocationWrist sprain +++ Imaging ++ X-ray for fracture, often limited viewComputed tomography (CT) scan for detailed imagingMRI ++ Pain with passive/active ROM of the wrist and thumbWrist will often be held in radial deviationMuscle guarding with all movementsInability to actively perform wrist or thumb movements secondary to pain Pain with gripping activities ++ For imaging, x-ray or CTFor medication: NSAID or opiod for pain managementFor immediate orthopedic consult: Distal scaphoid pole fractures are treated non-operativelyImmobilization casting of hand and may or may not include thumbWaist or proximal scaphoid pole fractures may be treated:Non-operatively, Immobilization cast of hand and thumbOperatively, open reduction internal fixation ++ Inability to perform activities of daily living with involved handInability to bear weight on involved handInability 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 ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.