Scaphoid Fractures - Everything You Need To Know - Dr. Nabil Ebraheim
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- čas přidán 9. 07. 2024
- Dr. Ebraheim’s educational animated video describes fractures of the scaphoid carpal bone.
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The scaphoid is the most common carpal bone to fracture. Fracture of the scaphoid usually occurs from a fall onto an outstretched hand. The patient usually experiences wrist pain and some swelling. The patient may not seek medical advice, thinking that this is a wrist sprain. The patient may get an x - ray and the x-ray intially may be negative (scaphoid fracture could be missed). The blood supply of the scaphoid bone is very unique. The fracture may have difficulty in healing. In fact, avascular necrosis of the proximal fragment may occur with fracture of the scaphoid bone. The scaphoid is a small bone, however if it fractured, there could be a bad result. Always look for tenderness at the anatomic "snuffbox" and pain on axial load. Even if the x-ray is negative, you should immobilize the wrist adequately with a thumb spica cast for a short period of time (10 days to 2 weeks).
When a fracture of the scaphoid occurs, it can be slow to heal due to the limited circulation of blood to the bone. The blood supply of the scaphoid is unique and tenuous. The primary blood supply enters the dorsal ridge and it runs retrograde to the proximal scaphoid. The dorsal blood supply comes from the dorsal carpal branch of the radial artery. The dorsal blood supply comes from the dorsal carpal branch of the radial artery and supplies the proximal 80% of the scaphoid through retrograde blood flow. The volar blood supply comes from the superficial palmar branch of the radial artery and enters the distal tubercle, supplying the distal 20% of the scaphoid. Scaphoid fractures can lead to nonunion and avascular necrosis due to interruption of the blood supply. The more proximal the fracture, the more likely that the fracture will develop nonunion and AVN.
The mechanism of injury for scaphoid fractures is axial load with hyperextension and radially deviation of the wrist. In general, if the fall onto the outstretched hand creates a force that leads to hyperextension, ulnar deviation, and intercarpal supination, then the fracture of the scaphoid may be associated with perilunate dislocation (it will be a transscaphoid perilunate dislocation).
Fractures Types:
Waist Fracture - About 65%. Transverse fracture is more stable. Most frequent fracture site and has moderate risk of AVN and nonunion.
Distal Third Fracture - Occurs in about 10%. Most common location in children (controversial).
Proximal Third Fracture - High incidence of nonunion and AVN. Fracture of the proximal pole has a nonunion rate of 40 - 50%.
Tuberosity Fracture - Rare.
RADIOLOGY
AP VIEW, LATERAL VIEW, SCAPHOID VIEW - Scaphoid view - 30° wrist extension and 20° ulnar deviation.
If the x-rays are negative and there is a high clinical suspicion of a scaphoid fracture, then immobilize the fracture and repeat the x-rays in 2-3 weeks. Bone scan will give fracture diagnosis in 72 hours. MRI can be used for early diagnosis of the fracture. MRI is very sensitive and will diagnose fracture in less than 24 hours. MRI can also show the AVN and vascularity of the proximal fragment of the proximal pole. CT scan may be helpful in diagnosing healing of the fracture. To check for nonunion, you get the CT scan along the scaphoid axis.
TREATMENT OF SCAPHOID FRACTURES
A thumb spica cast is used for stable, nondisplaced fracture or if the x-ray is negative, but there is a high index for suspicion of a scaphoid fracture. In this situation, you will put the thumb spica cast and reevaluate the patient in 2 - 3 weeks. Then remove the cast and get an x-ray. If the patient continues to have pain and the x-rays continue to be negative, then get an MRI and reapply the thumb spica cast and follow the patient closely. This is done because the patient has pain. If the patient does not have pain then get rid of the cast and do not get an MRI. The question is: Do you use a short or long arm thumb spica cast? What is the duration of time for the patient to wear the thumb spica cast? The period of immobilization and healing time of the fracture is decided by the location of the fracture. I think that the expected time for these fractures to heal in a thumb spica cast is: Distal pole - Healing occurs in about 8 weeks. Middle third (waist) - Healing occurs in about 8 - 12 weeks. Proximal third - Healing occurs in between 5 - 6 months. It takes a longer time for the proximal third of the scaphoid fracture to heal. Proximal fractures are very slow to heal in a cast.
If you’re here bc you found out you broke your wrist like I did, I wish you a speedy recovery! God bless!
Same
You're in for a lifetime of pain and discomfort if you broke your scaphoid. Broke mine at 15 I'm now in my 30s. Welcome to the bum wrist party 😎
@@user-dd1bb4tw4r I broke mine 4 years ago, had surgery. It's gotten pretty bad now. I'm thinking the SLAC surgery might be my best (or only) option. Have you looked into anything to get your strength back?
@@noah-ho4qb jo
@@user-dd1bb4tw4r k
Very helpful and informative, thank you very much!
Thank you for this amazing video ❤️
Brilliant again. Thank you.
I'm glad I came across this video. I fell due to my dog pulling on her leash too hard chasing a cat. I was sitting in a chair and fell all on my left side. I'm in a splint right now and waiting until Monday to see an orthopedic surgeon
I hope your recovery has gone well!
It was slow going but it went well
@@heatherplatt6400 how now are you ok . You must felling anything
Your videos are so helpful.
You have an Iraqi accent which is lovely and your content and method of delivery is amazing
thank you! this was really helpful. this isn’t and can’t be used as a replacement for a need to seek a doctor, but I was able to know that the best thing I could do while I wait for an appointment is to immobilise my wrist to avoid more nasty complications,
Fantastic summary!
love the fact where you used all the major languages ti say thankyou.... the video was really helpful
Excellent! Congrat!!
Always superb videos
I thought it was a wrist sprain at first! It started aching me TERRIBLY after 2 months when I thought it was almost done healing, turns out I was wrong, this video just changed the entire system!
Thats literally me right now
@@othmanbelkh6966 that’s me now
How's your wrist now?
@@cloxmith5233 its fine, just doesnt work like it did before
@@notverudah did you had surgery. ?
Very important information regarding scaphoid fractured
Interesting, many thanks.
Good job doctor
Thank u alot sir. For such a Very simple explanation, very easy to understand the concept of scaphoid for general people .. 🙏🙏🙏🙏
thanks alot , great explination
Thanks for the video
Fell while snowboarding at the end of March 2022, only took xrays 2 months later, did the surgery (screw) on June 12, and now I am 4.5 months after the surgery.
I can almost do anything except push-ups, I do them with knees to control the weight.
Need to do a CT scan and visit the surgeon
Ur still seeing the doctor for X-rays and stuff after surgery
Can you do push ups now?
Thank you sir.
Thank you sir :)
You really very proffisional excellent Dr
Thank you!!!
The high degree of articulation surface forced the limited inlet of blood supply avenues.
The amazing scaphoid a vital link in the overall function of the radial ulnar transmission system.
Thank You , Sir
Once again, great job. Thank you so much!
Thanks so much for this incredibly helpful video to inform me of my situation
very helpful lecture thanks doc
No info about tuberosity fracture ?
Why do you loose movement after a scaphoid surgery?
I have fallen from bike the x-ray is negative but I have constant pain Nd unable to hold anything even pen.
I had an accident more than 5 years ago and still live with the pain in that area.
It first happened 12 years ago and it healed by itself which is the reason i didn't went to the doctor until now.
The pain and the limited mobility of the wrist that i learned to live with until hiling doesn't seems to work now like before.
Is possible that the bone to be broken and dead? I work in industry so i need my hand very much. Thanks!
Bone dies out if the fracture is not treated in a timely fashion. It ll lead osteoarthiritis and SNAC so yes you can get disabled.
Very helpful for understanding, Dr. Ebraheim. I had a FOOSH fall from a forklift over 30 years ago just as was illustrated in this video. The left scapfoid was fractured. Now, I have degenerative athritiis.
I've had it about 20 years now. Such a bs bone.
@@user-dd1bb4tw4r Yessir! Correct. The sum bitch never really heals once fractured. Good health to you Will! Peace.
@@timothyr.hatchert.r.h.1458 thanks hope the cold and rainy days aren't too bad my friend!
@@user-dd1bb4tw4r Thanks. I appreciate the postive energy. May life be kind and minimally painful for you as well.
@@timothyr.hatchert.r.h.1458 30 years old bone fracture? Did you had surgery? How is your hand doing now brother?
شكرا 🌹
Your explanation is very detailed and informative. you are genius. I am diagnosed today with "Non-displaced fracture of scaphoid at distal pole on posterior aspect"; by CT Scan
How you treat, its beed surgery?
I fell on outstrectched hand and i did not give rest to my hand for 14 days and there was little pain in my hand when i try to move my hand in certain direction. I consult the doctor and he asked for an X Ray. My X ray did not show any fractures and he said it was a ligament tear and said to put on a thumb spica for 10 days. How good is this judgement?
now wt happened?
@Kushal Subedi - you posted 1 year ago, how are you now? Was it a fracture?
I'm going through this now. Back in December of last year I fell forward instead of backwards when coming up the front porch steps. Didn't think anything of it then by the second week of January my left wrist was swallon called the doctors and couldn't get in tell February he had xrays taken and was told nothing was broken but he said it's more an likely a sprain and had me ware a wrist brace......went back a month later as instructed. Then he sent my go and see a hand surgeon and saw him yesterday 4/28/22 and was told according to my MRI that the scaphoid fracture appears to be dead because of the group of 8 bones all where normal white bones except for the scaphoid bone. So now this doctor has me in cast for 6 weeks and has me scheduled for a CT scan next week to get a better understanding of it before scheduling me for surgery sorry for long story but I'm going crazy in the meantime because I'm currently unable to crochet.....😔😔😔😔😔😔😤😤😤😤
How is it now?
On 5/7/22, i had my surgery!
Untill now , i m on cast!
Doctor asked me to meet him on 15th of next month..
I got injured on Dec last year...
Pls tell ur experience after surgery and ur condition right now!
@@prashantrawat9707 hello Prashant can you give me your contact no. or social media link. I have scaphoid fracture, but I came to know about 6 months later. Please help me😥😥
@@prashantrawat9707 I want to know your experience, from where you had surgery. When was fracture detected, bone grafting???
@@ankush212 do the bone aches when it’s healing ??
@@user-fx6ys6yd6m yes a bit.
Took me 1 year of constant falling in my wrist due to skate boarding and not being able to flex my hand up to say that something must be wrong. I had my scalfoid bone taken out, and a piece of hip bone was shaped and put in as a scalfoid replacement
Hi, about 2 weeks ago I fell in an outstretched hand and it hurt for about 1 week and a half. I went to the decor when it stopped hurting and they think it is just a sprain but they suggest a mri to check for scaphoid fracture. can I still have a scaphoid fracture even if nothing hurts anymore at all when I move it. I just moved it for so long and nothing hurts anymore. Can it be a scaphoid fracture or do you think it’s just a sprain?
It's been 6 months since you posted - how are you now?
I fell on outstretched hand (Foosh) and when the pain persisted I had it x-rayed but was sent home without a cast. I immobilised it myself...
Did the bone healed?
@@user-fx6ys6yd6m Yes, it did - thank you!
@@gmr1241 What a good news brother. How long did it take to heal ?
@@user-fx6ys6yd6m Probably a few weeks if I remember - but not in any pain now. Is it something you've experienced?
@@gmr1241 surgery with bone graft. 3 month on cast . I dont know If the bone healed or not. X-Ray next week
I had my scaphoid fracture 1 year ago doctor suggest me go with surgery there is massive gap and he give me a wrist band and I used it then after 4 days the scaphoid in correct position but doesn't join what I have to do now I'm avoiding surgery please is there any method without surgery to join the scaphoid
On 5/7/22, i had my surgery!
Untill now , i m on cast!
Doctor asked me to meet him on 15th of next month..
I got injured on Dec last year...
Pls tell ur experience after surgery and ur condition right now!
I have a displaced scaphoid fracture. Seeing the surgeon in two days.
thanks u sir lov ❤ u
Tq sir
MRI vs CTscan?
Thank you D.
Please explean
Kienbock"s disease
Very very clear and simple explanation
I wish if i did see this video in the first month after i got injured i was so confused and thinking that i only has a sprained wrist, after 7 months figured out that i had a waist fracture “ arthritis “ i ended up having a surgery for it, i went well tho.
How is it doing now?
@@brenterickson9653 14 months past surgery now its much better, had it in a cast for 3months, removed the hardware (nail) in 6 and physical teraphy for an other 2
Now its like 98% normal.. i workout with a brace as a precaution
**Note i did physical therapy post cast for a month and post hardware removal for an other month
@@omar.aderdor hi please reply how is you wrist now?? I also thought it was sprain, now after 6 months I came to know it's scaphoid waist fracture. You had bone grafting also?
@@ankush212 so how is it?
@@prashantrawat9707 Prashant I remember I asked you how was your surgery. But you didn't reply. And now you are asking about me. We should help each other by sharing our experience, isn't it???. Ok I had my surgery on 24 September 2022. Till now my wrist ok. It's on a cast & they have immobilised my thumb & wrist. So far so good. I will update
Very interesting talk sir. Thank you. If necrosis develops what treatment is undertaken?
excision of the dead fragment with 4 corner fusion ( capitate-hamate-triquetrum-lunate) to prevent post excision collapse of the wrist joint
@@imagekhadka Thank you for this information. I suppose it is then a concern as to whether the fusions are reliable...?!
What is non Union and why is it bad? Debating on whether to get surgery, thanks
Non union means the fracture is not unioned meaning the fracture is still there. And the bone slowly dies which leads to SNAC and eventual OA
Proximal 5th?
Happened to me.cyst formed and then surgery had to be done
احتاج مساعد
🙏
I hurt my wrist 1 month and half and it still hurt like were is scaropid is at it hurt like crazy I pick up boxes everyday it hurt like crazy
How’s it going now?
@@Tqnvin it alright right
It alright right now
Now a days I have scaphoid cast but after 13 days pain still persists while it have to remove after 18 days.Can anyone tell me if it continued at the time of removal of cast what should be then?
How are you bro now. ? I have the same problem
how is ur fracture now?is it healed r not?
On 5/7/22, i had my surgery!
Untill now , i m on cast!
Doctor asked me to meet him on 15th of next month..
I got injured on Dec last year...
Pls tell ur experience after surgery and ur condition right now!
@@prashantrawat9707 I had a cast for 6 months after surgery. Scaphoid is still non union with necrosis and arthritis. You're gonna have all kinds of fun in the coming years 😄
@@user-dd1bb4tw4r broo show some emotions plss😔😔😔😭
I had the operation done nearly 4 years ago and still still hasn't healed properly
Then how you manage now . I had also same surgery screw were placed but not healing
Doctor sad lets see for 3 more months and if not heal properly then we will remove your scaphoid bone
What will i do ..plzz tell me
My last appointment a couple months ago ,I was told another operation maybe the only option,were they would redirect the blood into the bone, iv dont every thing the consultant said , I stopped smoking ,drinking ,I changed my diet and still hasn't healed , the worst case is that I will get athuritus(if spelt correctly) sooner than later ,maybe thats something I can live with
@@rohittanwar8383 I get by,it still gives me pain every day as I'm doing manual handling job ,it tightens up sometimes but its nothing I cant deal with really,sometimes I do need to give it a rest
i had this surgery on september 10th 2020. it’s November 2nd 2020 and my cast has been removed and doc says it’s healing fine. everything he said about the symptoms were true. thought it was sprained 😕
I had this surgery, how are you now
Is it healed completely?
@@venkataramakrishnamagapu7645 i lost some mobility in my hand, but i can bare weight on it, i can do everything i could before i broke it minus normal push-ups. i have to do close fisted push-ups now
@@issaredneck758 do you still have screw inside?
@@venkataramakrishnamagapu7645 yes. that screw is a permanent fixture
@@issaredneck758 yup, that's what my doctor told me.
Good hear positive experience.
Thank you
I am made of steel, never to be broken
Me 2........
Until 3 days ago
@@waynekerr8003 What happened and are you ok or at least improving now Wayne?
@@georgealderson4424 , broken scaphoid and scapular. Supposed to have a splint on now but break was bad , have 2 screws in it and the re cast it for another 4 weeks.
Dam motorcycles
I've had my scaproid break 6 years now
Ive also had the same problem
@@soljar187 its annoying and never know how it'd gonna feel the day after tommroow but life goes on wel get there
I’ve had mine for almost 2 years
Me almost two years
@@ThriveWithPurpose2024 well mine is still broken, it’s not that painful tho. Hope yous r not in constant pain
0:27 happened to me and now it hurts bad what do i do?
Get it checked asap if still hurts you after 4 or 5 weeks then it's scaphoid issue. I've had and now I have pin inserted. No worries though you'll be back to normal if you do good and constant physio.
I just got cast today after two weeks thinking it was just a sprain. But the pain was still quite bad so had X-rays done and it appears broken but alined. Now I am praying it will heal. :-(
@@starkiss77 Were you advised about surgery? Sometimes fracture is less than a hairline that you might not need a surgery. Trust me there's a light at the end of the tunnel. You should have that cast on 7 or 8 weeks. Let it heal good. No lifting and pressure on it.
@@jamisa3668 brother please tell me about the scaphoid facture please IAM suffering from scaphoid facture nearly 1 year
@@jamisa3668 brother is there any problem to me
Watching this with a swollen hand and a soft cast then in 4 days they want a hard cast, hand still swollen but told a distal radius fracture. Some Surgeon called.. Nope, not doing that..😬😳😂
my friend just went thru this surgery! He had a motorbike accident was just sore! ; his hand took all his weight! Did nothing about hand u til 4-6 weeks later! Thought it would be fine. The bone was turning black; mri showed. He is doing great. Do not be afraid. How would you like to lose use of hand?
@@bonnienero9415 The Creator of the Creation, The One True and Living God healed it perfectly, refused to have pins, screws and surgery.. If only people took time to read the most Distributed book in the History of Humanity the Holy Scriptures, The Bible.. In Logic..😕 I read The Book of John with Commonsense and The Book of Revelation.. I can see why Man made Religion and Pulpit Pimps with Mansions and sneaky sweet sounding words fool people. The Son of Man, Yeshua, The Lord Jesus spoke out against these Rat's and their fake doctrine used to control people. I pray other's speak to Him in a little Faith, He reveals ALL Truth.. Some people that get it about healing, love etc.. Isaiah Saldivar, Charles Lawson, Steven Bancarz, John Ramerize and The Last Reformation CZcams channel.. No fakes there.. Seek Truth and be healed inside and out..👏🙏💪☝👍
Troy, it's been a year since you posted, how did it go/ how is it going?
Hi, it all healed naturally, still as age moves forward so should increasing the strength around it.. Sometimes people forget we were originally formed while in the womb.. That forming still applies..😂 Thanks for asking and take care in this Chaotic World..👏🙏💪☝👍
Dayı Altayı iyileştir
Not English
What do u mean ( Not English).?Can’t u understand?
Oh some things we appreciate k on only after we lost 😢
I wish i never would have broken
Seeing my ortho today