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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.
The acetabular lines should then be carefully examined keeping in mind that the posterior rim, which is harder to see on X-rays, is more frequently fractured than the anterior rim (Figure 2). In the wrist, detection of carpal bone fractures is often challenging, with up to 18% of scaphoid fractures radiographically occult.
When the X-ray is diagnostic and there is a convincing Terry Thomas sign it is a static scaphoid instability. When the scaphoid is made unstable by either the patient or by manipulation by the examining physician it is a dynamic instability. [11] SNAC. In order to diagnose a SNAC wrist you need a PA view X-ray and a lateral view X-ray.
Scaphoid fractures are often diagnosed using plain radiographs and multiple views are obtained as standard. [9] However, not all fractures are apparent initially. [7] In 1/4 of cases, the clinical examination suggests a fracture, but the X-ray does not show it, even though there is indeed a fracture. [10]
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.
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This burst causes the scaphoid bone to dorsally rotate. [3] A gap of more than 3mm is pathognomonic for scapholunate dissociation. [4] The resulting separation between the scaphoid and lunate bones leaves a space on the x-ray that is similar to the gap comedian Terry-Thomas had between his front teeth.
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).