Hand anatomy overview bones, blood supply, muscles. Rule of 70s for scaphoid 70% of all carpal fractures occur at scaphoid. So, there is a risk that if you have a fracture in this area, it can sometimes stop the blood supply to part of the scaphoid bone, leaving part of the bone without a blood supply. The imaging assessment of suspected scaphoid fracture. A separate volar arterial branch to the scaphoid enters the tubercle and accounts for 2030% of the scaphoids blood supply, mainly to the distal. The radial artery is the primary source of blood supply to the scaphoid. Osteonecrosis of the elbow joint is an often missed diagnosis. Scaphoid vascularisation was investigated using macroscopic and microscopic techniques in 12 uninjured, formalin fixed cadaver hands. Displaced scaphoid fractures are seen on radiographs. It receives its blood supply primarily from lateral and distal branches of the radial artery. Current methods of diagnosis and treatment of scaphoid fractures. Review of the current methods in the diagnosis and. Sometimes a scaphoid non union is found quite by chance when xrays are taken of the wrist for other reasons.
Full text full text is available as a scanned copy of the original print version. This unusual retrograde nature of blood supply renders proximal. The extraosseous and intraosseous vascularity of the carpal scaphoid was studied in 15 fresh cadaver specimens by injection and clearing techniques. Like the scaphoid bone of the wrist, the elbow joint is extremely susceptible to this disease because of the tenuous blood supply of the articular cartilage. Injury to the scaphoid and its surrounding ligaments may significantly limit wrist function in the short term and can predispose patients to severe pain and. Then, the fracture will be fixed with a compression screw. The scaphoid also known as the os scaphoideum or historically as the navicular is the largest of the proximal row of carpal bones and forms the radial portion of the carpal tunnel.
The blood supply of the entire scaphoid is derived from vessels entering the distal portion of the bone. The laterovolar and the dorsal systems shared in the supply of the proximal two thirds of the scaphoid, while the distal group remained very see figure in the pdf file much circumscribed to the supply of the tuberosity. There is significant intercarpal motion between scaphoid and lunate, which questions the validity of present kinematic models of carpal motion. Because the scaphoid has a blood supply which comes from only one side it is prone to not healing. The scaphoid fracture first described in 1905 by destot, a french surgeon, anatomist and radiologist, derives its name from the greek word skaphos meaning boat.
Imaging and treatment of scaphoid fractures and their. Due to its poor blood supply, healing of a fractured scaphoid can be difficult but is important to wrist function and longterm health. Traumatic and reconstructive problems of the scaphoid. Scaphoid nonunion fracture the hand society handcare. An overview of the anatomy of the hand, including the bones of the hand, muscles, blood supply and nerve supply.
Articular surface 75% of scaphoid bone is covered by articular cartilage. Delayed union, malunion, or nonunion are often associated with fractures that are inadequately immobilized. The scaphoid bone is one of the carpal bones of the wrist. Unlike most bones the scaphoid bone has a fragile blood. Symptoms of a scaphoid bone fracture may include pain and swelling in the wrist, particularly near the base of the thumb. Scaphoid has unique anatomy to its credit when surrounding bones and its arterial supply is considered. More than 80% of the scaphoid surface is covered with articular cartilage. It also has a retrograde blood supply that leads to relatively high rates of avascular necrosis following fracture, particularly those closest to its most proximal end or pole. Current methods of diagnosis and treatment of scaphoid.
The extraosseous and intraosseous blood supply of the scaphoid. Treatment of problem fractures and nonunions of the scaphoid. The scaphoid receives its blood supply primarily from lateral and distal branches of the radial artery. The laterovolar and the dorsal systems shared in the supply of the proximal two thirds of the scaphoid, while the distal group remained very see figure in the pdf file much circumscribed to the. As per the law relating to information storage and personal integrity, you have the right to oppose art 26 of that lawaccess art 34 of that law and rectify art 36 of that law your personal data. Scaphoid nonunion s caphoid nonunion is challenging to manage because of the geometry of the scaphoid, the direction andtypeoffracture,andthevascular pattern of the blood supply to the scaphoid. Apart from contributing in forming the wrist, and helping in maintaining its flexibility and. The proximal pole depends on blood supply from the distal pole through the scaphoid bone. The scaphoid bone forms part of the wrist joint and interacts with the radius. Blood supply to the scaphoid bone is predominantly from branches of the.
This is where the blood supply enters the scaphoid bone. It is a boatshaped bone that is oriented obliquely with its long axis aligned from the medial portion of the distal radius proximally to the articulation of the 1 st and 2 nd metacarpals distally the scaphoid can be divided into proximal and distal poles. This can sometimes be disrupted by a crack across the waist of the bone. The scaphoid is vitally important for the proper mechanics of wrist function. Most commonly, a fracture occurs at the narrowest part of the scaphoid known as the waist. Primary vascular supply enters dorsal ridge and runs retrograde to the proximal scaphoid. Clinical examination a comprehensive collection of clinical examination osce guides that include stepbystep images of key steps, video demonstrations and pdf mark schemes. It receives its blood supply primarily from lateral and distal branches of the radial artery, via palmar and dorsal branches. I would also be interested to know whether he recommends this technique for use by general orthopedic surgeons in the treatment of problem fractures and nonunions of the scaphoid. Avascular necrosis of the hip is an often missed diagnosis. The scaphoid blood supply comes from the dorsal branch of the radial artery coursing retrograde proximal 80% of scaphoid and superficial palmar arch distal 20% of scaphoid. Microcirculation is an important factor in bone healing and may be compromised in fractured scaphoids because its blood supply comes from the distal end. How to draw the blood supply of the scaphoid, frcs orth revision.
Since the scaphoid blood supply comes from two different vascular branches of the radial artery, fractures can limit access to blood supply. Nonunion of fracture of the carpal scaphoid in a child. The extraosseous and intraosseous blood supply of the. What links here related changes upload file special pages permanent link. In case of a proximal scaphoid fracture, the blood. Scaphoid bone definition, location, anatomy, diagram.
The ability of eswt to enhance microcirculation parameters in soft tissue was of interest to determine if it improves microcirculation in the. Scaphoid links the proximal and the distal carpal rows. If that supply is cut off by a fracture in the neck or proximal third of the scaphoid, the entire bone is in jeopardy, as the bone will not receive the nourishment it needs to repair itself. Blood supply major blood supply is dorsal carpal branch branch of the radial artery enters scaphoid in a nonarticular ridge on the dorsal surface and supplies proximal 80% of scaphoid via retrograde blood flow. Unlike most bones the scaphoid bone has a fragile blood supply.
Osteonecrosis is said to occur in %50% of cases of fracture of the scaphoid, and the incidence of osteonecrosis is even higher in those with involvement of the proximal one. Because blood supply is needed to heal a fracture, the. Since blood supply is available from the palmar circulation, a dorsal approach to the scaphoid bone is possible. Diagnosis and management of scaphoid fractures american. Enter through numerous small foramina along the spiral groove and dorsal ridge. The specific blood supply in combination with the demanding functional requirements can easily lead to disturbed fracture healing. The dorsal scaphoid branches from the radial artery enter the nonarticular portion of the scaphoid at the dorsal ridge at the level of the waist and. A good blood supply of the scaphoid bone from palmar, dorsal and radial vessel groups with a variety of anastomoses was found which should provide sufficient collateral blood flow from adjacent regions in some patients. When applied to the proximal pole of the scaphoid, this showed the venous drainage to be via the dorsal ridge into the venae comitantes of the radial artery. Fracture proximal to the perforating vessels on the dorsoradial surface of the scaphoid can cause significant bone ischemia of the proximal pole. Fractures of the scaphoid bone mainly occur in young adults and constitute 27% of all fractures. This can lead to problems with healing if it is not treated carefully. If the scaphoid is broken, the few tiny blood vessels that supply the bone with nutrients can be damaged. To avoid missing this diagnosis, a high index of suspicion and a thorough history and.
Similar to the scaphoid, the hip is extremely susceptible to this disease because of its tenuous blood supply. When the scaphoid bone is broken, it may not heal properly because it has a very fragile blood supply. The blood supply of the hip is easily disrupted, often leaving the proximal portion of the bone without nutrition, thereby leading to. The extraosseous and intraosseous blood supply of the scaphoid bone. Volar branch enters the scaphoid tubercle and supplies its distal 20% to 30%2. Scaphoid fractures are more common in younger males1 and often result from a fall onto an outstretched hand.
In surgical treatment, holes are drilled and a screw is placed across the fracture to realign the bones and support the site while it heals. There is a rare accessory bone os centrale carpi that can resemble a fracture. Pdf fractures of the scaphoid, diagnosis and management. The blood supply to the scaphoid comes from two branches of the radial artery.
Basic sciences blood supply of the scaphoid youtube. Figure 12a with new distal pole fracture indicated by an orange line and healed waist fracture indicated in dashed blue complications the blood supply of the scaphoid is from 2 blood vessels. Patients with scaphoid fractures most often present with wrist pain and with tenderness and fullness in the anatomic snuffbox. The fracture can disrupt the bones blood supply, impairing the healing. The scaphoid can be injured when a significant load is placed on the extended wrist, such as a fall onto an outstretched hand. The main blood supply to the scaphoid is from the radial artery.
Because of the scaphoid bones poor blood supply, scaphoid fractures can take a longer time to heal than other fractures. The proximal vessel seen in one specimen was of very small caliber and limited penetration. The proximal pole of the scaphoid relies entirely on intramedullary blood flow. These provide an abundant supply to middle and distal bone, but neglects the proximal portion, which relies on retrograde flow. The blood supply of the scaphoid comes scaphoid fracture is a common injury encountered in family medicine. Blood vessels enter through the dorsal ridge and tuberosity. A good blood supply of the scaphoid bone from palmar, dorsal. An animated description of the blood supply to the scaphoid and its impact on fracture healing. With or without surgery, patients may need to wear a cast or splint for up to 6 months.
Blood flows from the topdistal end of the bone in a retrograde fashion down to the proximal pole. Xrays are routinely taken of the scaphoid as it heals. The blood supply of the scaphoid is unique and tenuous. No direct blood supply to proximal portion of the bone. The scaphoid is the largest of the proximal row of carpal bones and sits on the radial side of the lunate. The diagnostic strategy of suspected scaphoid fractures, however, is surrounded by controversy. The palmar scaphoid branch arises from the superficial palmar. It is important for stability and movement at the wrist and may be fractured after a fall onto a hyperextended hand. Scaphoid fractures only account for 2% of all fractures but is second only to femoral head for posttraumatic avn. The management of acute scaphoid fractures should be oriented on the concept of fracture stability, ease of reduction, associated ligamentous injury, and risk of impaired blood supply, rather than the direction of the fracture line or location of the fracture within the scaphoid. This blood supply is easily disrupted, often leaving the proximal portion of the bone without nutrition and leading to osteonecrosis figure 401. Fracture of the scaphoid bone is the most common carpal fracture. Get a printable copy pdf file of the complete article 800k, or. Background injuries to the wrist and carpus are common presenting complaints to the emergency department.
Because blood supply is needed to heal a fracture, the scaphoid often takes a long time a few months to heal. The blood supply of the scaphoid is primarily from the radial artery via the artery to the dorsal ridge of the scaphoid, whose branches enter the scaphoid via. Avascular necrosis an overview sciencedirect topics. Full text get a printable copy pdf file of the complete article 819k, or click on a page image below to browse page by page. Scaphoid blood supply two major vascular pedicles1. Scaphoid bone normal anatomymechanism of injury imaging the scaphoid is the most frequently injured carpal bone, accounting for 60% to 70% of all carpal fractures.
Scaphoid fractures may be radiologicallyoccult in the acute setting and may result in. Scaphoid fractures can lead to nonunion and avascular necrosis due to interruption of the blood supply. Most of the blood supply derives from branches of the radial artery that penetrate the scaphoid distally and supply 70%80% of the more proximal bone, thus giving rise to the problem of a higher rate of nonunion and avascular necrosis in more proximal fractures. Cast duration most scaphoid fractures are managed in a cast for 612 weeks some ready at 4 weeks geoghegan et al 2009 found that 86% of patients had radiographic union on. In scaphoid fracturesespecially those in which the bone fragments have become displacedthe blood supply to the bone may be disrupted. Diagnosing and treating scaphoid fractures of the wrist. Due to this perfusion pattern, the scaphoid bone is prone to nonunion after fracture. The dorsal carpal branch of the radial artery is responsible for about 75% of the blood supply to the scaphoid, while the superficial palmar arch branching from the volar radial artery provides the minor blood supply 9.1493 14 422 487 29 387 832 1527 664 962 52 239 302 1443 494 307 1313 483 1195 1070 786 772 1065 969 1251 139 921 548 106 306 557 1214 827 665 1363 1254 1052 665 720 1455 899 726 858