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Scaphoid fracture. Review of diagnostic tests and treatment.

Schubert HE. Can Fam Physician 2000 Sep;46:1825-32.

OBJECTIVE.
To help make diagnosis and treatment of scaphoid fracture more precise by review of published evidence.

QUALITY OF EVIDENCE.
MEDLINE was searched using the terms “scaphoid,” “carpal navicular,” “fracture,” “computed tomography,” “bone scan,” and “scintigraphy.” Most papers were case-series observational reports. Papers were cited if the case series was large or if there was a high degree of agreement among several observers. The main recommendation for change in treatment of scaphoid fracture is based on two randomized clinical trials involving more than 1000 patients with proven scaphoid fracture.

MAIN MESSAGE.
Fracture of the scaphoid requires a specific mechanism of injury. “Snuffbox” tenderness is not specific for scaphoid fracture and is not the most useful physical finding; other physical findings provide more specific evidence for or against scaphoid fracture. Physical examination remains the basis of initial treatment and should be thorough and meticulous. X-ray films must be of high quality and should be examined carefully for bone and soft tissue signs of fracture. A Colles’-type short arm cast is adequate for treating common undisplaced scaphoid waist fractures; the thumb need not be immobilized. For suspected scaphoid fractures, without radiologic evidence of fracture, treating symptoms is likely sufficient.

CONCLUSION.
Evidence found in the literature can be used to improve diagnostic accuracy for scaphoid fractures, to optimize treatment for these injuries, and to reduce unnecessary immobilization and disability for patients.

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