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In general, if you see a fracture of the scaphoid, you should also exclude what two injuries?
Perilunate dislocation
Capitate fracture
For nondisplaced fractures of the scaphoid, what is the preferred time of immobilization for distal pole fracture?
6 weeks
What is the preferred time of immobilization for scaphoid waist fracture?
12 weeks
What is the preferred time of immobilization for proximal pole fracture? Thus, what should be considered?
5 months
Consider surgery for proximal pole fractures even if nondisplaced
ls it generally necessary to include the thumb in the cast?
No proven benefit to including the thumb (controversial)
What is the reported advantage of a long arm cast over a short arm cast?
Decreased time to union
What radiographic findings are suggestive of an unstable scaphoid fracture?
Humpback deformity (flexed and shortened)
Displacement >1 mm
Scapholunate angle >60 degrees
Capitolunate angle >15 degrees
What is the treatment of choice for unstable scaphoid fractures?
ORIF
ORIF remains an option for a missed fracture for how long?
Until arthritic changes are seen
Generally up to 5 years after injury
What is the blood supply to the scaphoid?
Major: dorsal scaphoid branch of the radial artery in a retrograde fashion (supplies 70 to 80%, including entire proximal pole)
Volar scaphoid branch of the
superficial branch of the radial artery in a retrograde fashion (supplies 20 to 30% distal of scaphoid)
What is the avascular necrosis (AVN) rate for a proximal 1 /5 fracture?
100%
What is the AVN rate for proximal 1 /3 fracture?
33%
ln terms of vascular supply, which approach to the scaphoid is generally safer?
Volar approach, because blood supply enters distally and dorsally
At what anatomic location is the dorsal approach considered safe from a vascular standpoint?
Dorsal approach is safe proximal to the ridge on the waist
What is the plane of dissection for the volar scaphoid approach?
Between FCR and radial artery
What two structures should be repaired once volar surgery is complete?
Long radiolunate ligament
Radioscaphocapitate
The dorsal approach is generally used for what type of scaphoid fracture?
Proximal pole fractures
What two structures must one be careful to avoid?
Superficial radial nerve
Radial artery (deep)
At the time of surgery, the proximal pole is known to be vascularized in what situation?
lf it is observed to bleed
. If the scaphoid fractures goes on to what are the available graft types?
Inlay: if no associated collapse (92% nonunion, union rate)
lnterposition: if associated collapse or scaphoid deformity present (70 to 90% union rate)
A vascularized graft should be used for?
Scaphoid nonunion with AVN
On what artery is the vascularized graft based?
1.2 intercompartmental
supraretinacular artery