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Patient suffered prior FOOSH type injury. 

No prior surgeries,  carcinoma  or corticosteroid/opioid regimen reported.

What do you see?

A cannulated screw transfixes the  waist scaphoid fracture. This is a common treatment for internal fractures with > 1. 5 mm. displacment.  (2)

As the majority of the scaphoid (8)%) is covered with articular cartilage, entry points for internal fixation are limited. (3)

Wrist- anatomic model showing  scaphoid fracture fixation. 

Coronal fat-sat MRI- arrows pointing to bone marrow edema and mid waist fracture line.

25 yo/M electrician showing mid waist fracture seen on  older tomogram image.

Follow up image – 2 years show advanced radial carpal collapse. 

Early detection with MRI is essential for improved surgical outcomes.

 

DISCUSSION: After a FOOSH type injury, scaphoid fractures account for a large number of carpal fractures. 

The majority are mid-waist fractures. If plain radiographs do NOT detect 5-20% of fracture, ulnar deviation views are helpful.

If clinical symptoms persist, the most sensitive modality-MRI-will detect subtle fractures and evaluate for osteonecrosis. (1)

REFERENCES:

  1. https://radiopaedia.org/articles/scaphoid-fracture
  2. EFORT Open Review 2020; 96-103   DOI: 10.1302/2058-5241.5.190025
  3. https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/carpal-bones/scaphoid-waist/screw-and-k-wire-fixation#reduction