Scaphoid fractures in the athlete
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Scaphoid fractures are a common wrist injury, especially in athletes. Clinicians should have a high index of suspicion for a scaphoid fracture in any patient complaining of radial-sided wrist pain after a fall on an outstretched hand. Advanced imaging, including CT and MRI scans, may be useful in diagnosis and classification of fracture patterns. Treatment varies based on the fracture location, stability of the fracture, and predictability of the fracture to heal. Treatment involves either non-operative management with a thumb spica cast or brace, or operative fixation with a headless compression screw, k-wires, or scaphoid-specific plates. Return to play is dependent on many variables, including sport, fracture union, and ability to play with cast.
KeywordsScaphoid fracture Athlete
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Conflict of interest
Mark J. Winston declares that he has no conflict of interest.
Andrew J. Weiland reports personal fees from Medartis and Arthrex, outside of the submitted work.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 1.Geissler WB, Slade JF. Fractures of the carpal bones. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s Operative Hand Surgery, Sixth ed. Elsevier; 2011.Google Scholar
- 3.Rettig AC, Ryan RO, Stone JS. Epidemiology of hand injuries in sports. In: Strickland JW, Rettig AC, editors. Hand injuries in athletes. Philadelphia: WB Saunders; 1992. p. 37–48.Google Scholar
- 6.• Patel NK, Davies N, Mriza Z, Watson M. Cost and clinical effectiveness of MRI in occult scaphoid fractures: a randomized controlled trial. Emerg Med J. 2013;30(3):202–7. Looked at patients with suspected scaphoid injuries. Half of patients were treated with thump spica casting and repeat X-rays 2 weeks later. The other half of the study population received immediate MRI. If MRI was negative, the patient was discharged with no follow-up. Early MRI group had cost savings compared to control group given avoidance of cast fees and fewer clinic appointments. They also had earlier return to work and sporting activities. Google Scholar
- 16.Herbert TH. The fracture scaphoid. St Louis: Quality Medical Publishing; 1990.Google Scholar
- 17.• Everding NG, Evans PJ. Scaphoid Fractures in the Athlete: Acute and Chronic. The Athlete’s Hand and Wrist: A Master Skills Publication. Chapter 13. Chicago: American Society for Surgery of the Hand; 2014. Comprehensive text for evaluation and treatment of all common injuries seen in athletes.Google Scholar
- 18.Haisman JM, Rohde RS, Weiland AJ. Acute fractures of the scaphoid. An instructional course lecture. J Bone Joint Surg. 2006;88-A(12).Google Scholar
- 20.Richards RS, Roth JH. Common wrist injuries. In: Chan KM, editor. Sports Injuries of the Hand and Upper Extremity. New York: Churchill Livingstone; 1995. p. 214–5.Google Scholar
- 22.Dias JJ, Brenkel IJ, Finlay DB. Patterns of union in fractures of the waist of the scaphoid. J Bone Joint Surg (Br). 1989;71(2):307–10.Google Scholar
- 23.Ford DJ, Kjoury G, el-Hadidi S, et al. The Herbert screw for fractures of the scaphoid. A review of results and technical difficulties. J Bone Joint Surg (Br). 1987;69(1):124–7.Google Scholar
- 25.• Bond CD, Shin AY, McBride MR, et al. Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures. J Bone Joint Surg Am. 2001;83-A(4):483–8. Study compared scaphoid fractures treated nonoperatively and operatively in military recruits, which closely resembles an athlete with return to play.CrossRefPubMedGoogle Scholar
- 26.Cooney WP, Dobyns JG, Linscheid RL. Fractures of the scaphoid: a rational approach to management. Clin Orthop. 1980;149:90–7.Google Scholar
- 33.• Dy CJ, Khmelnitskaya E, Hearns KA, Carlson MG. Opinions regarding the management of hand and wrist injuries in elite athletes. Orthopedics. 2013;36(6):815–9. Includes surveys of surgeons taking care of professional athletes in different sports and preferences for return to play.CrossRefPubMedGoogle Scholar