2.  Derived from greek word ‘scaphos’ meaning boat
ï‚— Boat or cashew shaped bone
 Rule of 70 for scaphoid –
 Accounts for 70% of carpal fractures
 Of these 70% occur at waist
 70% of scaphoid fractures unite
 70% of vascular supply is through dorsal branch of
radial artery
3. ï‚— Boat or cashew shaped
ï‚— 80% of bone covered by articular surface expect
tubercle
 Located in a 45° plane to horizontal
and vertical axes
•
4.
5.
6.
7.
8. ï‚— Common in young adults
ï‚— Fall on outstretched hand
 Mechanism – Bending with
compression dorsally and tension
on palmar surface owing to forced
dorsiflexion
9. ï‚— Proper history about mechanism of injury
ï‚— Clinical examination
 Radiographic evaluation –
 X-ray – PA view, lateral, Radial oblique, ulnar
oblique, Scaphoid view
 MRI – 100% sensitivity even in 48 hrs
 Tc 99 bone scans also have high sensitivity in occult
fractures
10.
11.
12.
13. 80 %
15%
5%
Time to union – 4-6
weeks
Time to union – 10-
12 weeks
Time to union – 12-
20 weeks
14. Type A
Stable Acute fracture
A1 : Fracture through tuberosity
A2 : Incomplete fracture through waist
HERBERT AND FISHER
CLASSIFICATION
15. Type B
Unstable Acute Fractures
Type B1: Distal Oblique Fracture
Type B2: Complete Fracture of Waist
Type B3: Proximal Pole Fracture
Type B4: Transscaphoid-
Perilunate
Fracture-Dislocation
of Carpus
Type B5: Comminuted
Fractures
16. Type C Delayed Union
Type D
Established Nonunuion
Type D1: Fibrous Union
Type D2: Pseudarthrosis
17.
18. Type 1 – Tuberosity
fracture
Type 2 - Distal intra-
articular fracture
Type 3 –
Osteochondral
fracture
19.  Occult Fractures – Colles cast for 4-6 weeks
 Type A1 – Colles cast cast for 4-6 weeks
 Type A2 – Below elbow cast in neutral position cast c
ast for 6-12 weeks in low demand patients
in other patients ïƒ percutaneous screw fixation
A displaced fracture is defined as one with more than 1 mm of step-off or more than
60 degrees of SL or 15 degrees of lunato-capitate angulation as observed on
either plain radiographs or CT scans.
21.  Type B2 – Percutaneous screw fixation
- in case reduction cannot be achieved, open
reduction and internal fixation
- Cast required in case of asso. ligamentous injury
In case of hump-back deformity, bone-grafting may be
required
Hump-back deformity
22. ï‚— Type B3 - closed or open reduction and screw fixation
through dorsal approach
31.  Type D1 – Open reduction and screw fixation with
bone gafting- either from distal radius or iliac crest
 Success – 60-95%
 Type D2 – Open reduction and internal fixation with
bone graft or vascularised bone graft – pronator
quadratus