Case

A 23yo playing basketball lands on their outstretched hand on the palmer side. The hand was sore for most of the day and the patient went to the emergency room for an x-ray which showed no fractures. The emergency room indicated there was no bony injury and sent the patient home. Several days later there is still considerable pain that is not getting better the patient presents to physiatrist. The physiatrist notes particularly prominent pain upon palpation of the anatomic snuffbox. There is minimal discomfort when the forearm and elbow are examined and palpated. Normal sensory responses are present in all five digits.

Question 2/3 - A scaphoid fracture is confirmed by a repeat x-ray performed 2-3 weeks after the injury. What intermediate to long term sequelae (i.e. consequence or additional condition developing) is the physiatrist most concerned about?

Click on your selected option(s) below  (correct = 1, over-thinking = 2+)

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Incorrect. The bone is unlikely to heal out of position due to the various ligaments connecting the carpal bones. An improper setting of the bone is more likely with a long bone such as the radius (e.g. Colle's fracture) where reduction (repositioning) and immobilization or fixation to reposition the bones may be needed. 

Incorrect. Digit 5 is the little finger and the scaphoid bone is on the thumb side of the wrist. Additionally, the scaphoid bone is in the first row of carpal bones and does not form a joint with the metacarpal bones.

Carpal bone rows are remembered by the mnemonic
"So  Long to Pinky...Here Comes The Thumb", with scaphoid and lunate the most important to know.

First row = (thumb side) Scaphoid, Lunate, Triquetrum, and Pisiform (little finger side).

Second row = (little finger side) Hamate, Capitate, Trapezoid, Trapezium (thumb side).

Correct!  Due to the retrograde blood flow into the scaphoid bone it is susceptible to a high rate of non-union.  This non-union can lead to bone necrosis and collapse. 

Incorrect. Joint motion is typically checked (limited) by various ligaments. Most of the time excessive motion at a joint would be the result of a ligament injury more likely than boney injury. In the case of excessive radial deviation, wrist ligaments on the ulnar side would need to have ruptured, and the scaphoid is on the radial side of the wrist. 

Incorrect.  SLAC wrist stands for Scapholunate Advanced Collapse, a condition that occurs with disruption of the scapholunate ligament resulting in widening and wrist instability (thus the 'slack' pronunciation of SLAC, drawing analogy to slackness in the wrist position).

Incorrect. The closest nerve passing to the scaphoid bone is the median nerve through the carpal tunnel. Inflammation around the injured scaphoid bone could cause temporary neuropathy, but probably not a long term sequelae as with proper healing inflammation should subside.

Additionally, the median nerve at this point is a motor and sensory nerve (sensory to 3.5 digits/palm and motor to thenar muscles) so injury would not be selective to sensory neuropathy only and would have associated motor deficit.