Scaphoid Fractures * The scaphoid is the most frequently fractured carpal bone, accounting for 71% of all carpal bone fractures. * Scaphoid fractures often occur in young and middle-aged adults, typically those aged 15-60 years. * About 5-12% of scaphoid fractures are associated with other fractures * 70-80% occur at the waist or mid-poion * 10-20% proximal pole Management # Proximal pole -- Depends on size and vascularity of fracture -- Growing sentiment that most should be treated operatively because of high propensity for non-union and increased duration of immobilisation required for non-operative management -- If large enough to accommodate a screw than every attempt should be made Complication * Malunion -- Malunion may lead to limited motion about the wrist, decreased grip strength, and pain. -- The most frequent pattern of malunion is persistent angular deformity, or the humpback deformity. -- Malunion usually can be treated with osteotomy and bone grafting to correct angular deformity and length. * Literature confusing with no comparative studies to document improvement in hand function * Delayed union and non-union -- Delayed union is incomplete union after 4 months of cast immobilization. -- Non-union is an unhealed fracture with smooth fibrocailage covering the fracture site. -- About 10-15% of all scaphoid fractures do not unite. -- Some degree of delayed union or non-union occurs in nearly all proximal pole fractures and in 30% of scaphoid waist fractures # Delayed union is anticipated if fracture treatment is delayed for several weeks. # The risk of non-union increases after a delay of 4 weeks. * These delays may be related to the patient&;s failure to seek treatment for a presumed sprain, but they more frequently are related to improper or incomplete immobilization or a failure to diagnose and treat the acute fracture ref : maheswari 9th ed