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In metaphyseal areas, delayed signs of fracture include a band of sclerosis perpendicular to the trabeculae, while diaphyseal fractures may present as periosteal thickening. [1] Digital radiography known as tomosynthesis has been shown to be superior to conventional radiographs in the detection of occult fracture of the scaphoid.
A scaphoid fracture is a break of the scaphoid bone in the wrist. [1] Symptoms generally includes pain at the base of the thumb which is worse with use of the hand. [ 2 ] The anatomic snuffbox is generally tender and swelling may occur. [ 2 ]
Anatomic illustrations of the wrist depicting the progressive stages of scapholunate advanced collapse. (A) Normal wrist demonstrating an intact scapholunate ligament (white arrowhead), normal scapholunate interval, and preservation of the joint spaces. (S = scaphoid, L = lunate, C = capitate, R = radius, U = ulna).
In the event of inordinate application of force over the wrist, this small scaphoid is likely to be the weak link [citation needed]. Scaphoid fracture is one of the most frequent causes of medico-legal issues. An anatomical anomaly in the vascular supply to the scaphoid is the area to which the blood supply is first delivered.
Scapholunate advanced collapse is the most common form, followed by scaphoid non-union advanced collapse (SNAC). [3] Other post-traumatic causes such as intra-articular fractures of the distal radius or ulna can also lead to wrist osteoarthritis, but are less common.
Osteosclerosis is a disorder characterized by abnormal hardening of bone and an elevation in bone density. It may predominantly affect the medullary portion and/or cortex of bone.
The scaphoid can be slow to heal because of the limited circulation to the bone. Fractures of the scaphoid must be recognized and treated quickly, as prompt treatment by immobilization or surgical fixation increases the likelihood of the bone healing in anatomic alignment, thus avoiding mal-union or non-union. [6] Delays may compromise healing.
Preiser disease, or avascular necrosis of the scaphoid, is a rare condition where ischemia and necrosis of the scaphoid bone occurs without previous fracture.It is thought to be caused by repetitive microtrauma or side effects of drugs (e.g., steroids or chemotherapy) in conjunction with existing defective vascular supply to the proximal pole of the scaphoid.