over each pole of the scaphoid and compressing. If pain is elicited, this likely indicates the presence of a scaphoid fracture (Hayat & Varacallo, 2023). Clinical Presentation Symptoms of scaphoid fractures include pain and swelling at the base of the thumb (in the anatomic snuffbox). There may be loss of wrist range of motion. Subjective history will typically include wrist pain following trauma. Often, initial diagnosis is missed on plain x-rays, so these injuries are seen late. Smokers with this injury have an increased risk of nonunion of about 20% (Hayat & Varacallo, 2023). Clinicians should focus subjective interviews on the patient’s onset of pain and possible mechanism of injury as well as history of smoking to be able to appropriately identify a possible scaphoid fracture. Examination will classically reveal tenderness in the anatomic snuffbox dorsally. The anatomic snuffbox is the area between the first and third extensor compartments, with the abductor pollicis longus and extensor pollicis brevis tendons forming the radial border and the extensor pollicis longus tendon forming the ulnar border. There may be tenderness over the scaphoid tubercle on the volar aspect, which can be palpated as the bony prominence radial to the flexor carpi radialis at the level of the palmar crease (Hayat & Varacallo, 2023). activities and motor vehicle crashes. In the elderly, decreased bone density is associated with this injury, with onset related to falling on an outstretched arm when standing. Clinical Presentation Clinical examination may reveal ecchymosis, tenderness, and swelling. Range of motion of the wrist joint will be limited and painful (Szymanski et al., 2023).
wrist when landing. This can help the clinician be aware of the possible presence of a scaphoid fracture. There is a strong association of scaphoid fracture with avascular necrosis (AVN), with a 100% rate of AVN if the proximal segment of the scaphoid is fractured. This decreases to a 33% rate if the distal segment is fractured (Hayat & Varacallo, 2023). Examination will classically reveal tenderness in the anatomic snuffbox dorsally. The anatomic snuffbox is the area between the first and third extensor compartments, with the abductor pollicis longus and extensor pollicis brevis tendons forming the radial border and the extensor pollicis longus tendon forming the ulnar border. There may be tenderness over the scaphoid tubercle on the volar aspect, which can be palpated as the bony prominence radial to the flexor carpi radialis at the level of the palmar crease (Hayat & Varacallo, 2023). The location of tenderness can help differentiate which part of the scaphoid is fractured. Tenderness at the volar prominence at the distal wrist indicates distal pole fracture, tenderness over the anatomic snuffbox indicates mid-body scaphoid fracture and tenderness distal to Lister’s tubercle indicates proximal pole fracture (Hayat & Varacallo, 2023). Pain in the anatomic snuffbox with ulnar deviation of the wrist suggests scaphoid fracture. The scaphoid compression test is more sensitive for detecting scaphoid fractures. It involves placing the examiner’s index finger and thumb Barton fracture A Barton fracture is an oblique fracture of the distal radius that extends to the articular surface. The resultant triangular fragment is sheared off and displaced dorsally or volarly. The wrist bones are similarly displaced (Wong et al., 2015). The radiocarpal ligaments are not disrupted, and the articular surface of the fractured distal radius remains in contact with the proximal carpal row (Szymanski et al., 2023). When the displacement is dorsal, this is known as a Barton fracture . When the displacement is volar, it is known as a reverse Barton fracture (Wong et al., 2015). Mechanism of injury varies by age. In children and young adults, most Barton fractures are the result of sporting Chauffeur fracture A chauffeur fracture is an oblique fracture of the radial styloid process with the wrist in extension. Its name comes from a time when motor vehicles were started by means of a crank handle. The crank handle could unexpectedly jerk back and cause a wrist injury due to sudden hyperextension (Andreotti et al., 2020). These fractures may be associated with ligamentous rupture and resultant carpal instability (Turan et al., 2019). Fracture of the ulnar styloid process Ulnar styloid process fractures are commonly associated with distal radius fractures (Chen et al., 2020). They may occur independently with a direct blow to the distal ulnar wrist (Nakamura et al., 2020). The ulnar styloid process is an insertion site for the triangular fibrocartilage complex (TFCC), so fractures to this site may result in instability of the distal radioulnar joint (Nakamura et al., 2020). Fracture of the hook of the hamate Several mechanisms can lead to fracture of the hook of the hamate, including blunt trauma, repetitive microtrauma, and avulsion injury. A fall on an outstretched hand, motor vehicle crash, and direct trauma from a projectile such as a baseball are common traumatic causes of this injury. Gripping-related trauma is associated with holding a bat, racket, golf club,
Clinical Presentation Clinical presentation Includes swelling and tenderness over the radial styloid process. Nondisplaced fractures are typically treated with casting, while displaced fractures typically undergo surgical fixation (Turan et al., 2019).
Clinical Presentation Clinical presentation includes wrist pain, limited wrist motion, localized swelling, and tenderness with palpation. Diagnosis is confirmed with radiographs. Nondisplaced fractures are treated conservatively with casting, while displaced fractures require surgical fixation (Roland, 2018). or bicycle handle. Repetitive microtrauma can result from holding a bat, racket, or golf club. Avulsion fractures can occur as a result of ligamentous or tendinous forces tugging on the hamate (Davis, 2017). Soft-tissue injuries associated with hook of the hamate fractures include ulnar nerve palsy and tear of the fifth finger flexor tendons (Davis, 2017).
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