Scaphoid fracture

The wrist can be separated into three parts, namely, radial column, central column, and ulnar column. The radial column includes the scaphoid fossa of the radius, scaphoid, and scapho-trapezium-trapezoidal joint; the central column includes the lunate fossa of the radius, lunate, and capitate; and the ulnar column includes the ulnar head, triangular fibrocartilage complex (TFCC), triquetrum, and hamate. Major pathology of the radial column is scaphoid fracture, because the fracture itself is easily misdiagnosed due to difficulty in delineating the fracture line by X-ray in posteroanterior and lateral views. Kienbock disease falls under the purview of central column problem and TFCC injury falls under the purview of ulnar column problem. Scapholunate ligament injury is categorized under both radial and central column problems. As the scaphoid is a strut to keep the length of the wrist, unstable scaphoid fracture makes the scaphoid flex and the wrist can no longer keep its length, showing dorsal intercalated segmental instability (DISI) deformity and carpal instability. Also, blood supply of the scaphoid proximal side is quite unstable, and sometimes we observe, necrosis of the proximal pole. That is why early diagnosis of the scaphoid fracture by CT or MRI is important, and adequate surgical treatment is necessary for unstable scaphoid fracture, especially among adults.

In this issue, the “special review” is “Scaphoid fractures below the age of 10: Case series and review of the literature” by Dr. Tataria et al. They concluded that MRI is useful for diagnosis, and nonoperative management of scaphoid fractures was feasible below the age of 10 years. These results may be due to aggressive healing potential and strong blood supply of the scaphoid at these ages. Interesting wrist papers pertaining to long-term results of pisiformectomy, ganglion cyst, biomechanical study of the bridging plate for distal radius fracture, scapholunate ligament treatment, as well as interesting case reports and procedures for scaphoid nonunion are also included in this issue. Do not miss them!

Publication History

Article published online:
01 December 2020