Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Scaphoid Fracture

SYMPTOMS

There is localised pain and swelling over the medial base of the wrist. Wrist movement and gripping are painful. It is common in ice hockey, rugby, handball and similar sports.

AETIOLOGY

These symptoms are caused by fracture of the scaphoid bone through trauma caused by a direct fall on to an outstretched hand or direct impact. The prognosis varies depending on whether there is vascular disruption leading to avascular necrosis.

CLINICAL FINDINGS

There is localised tenderness on palpation over the ‘snuff box’ overlying the scaphoid, aggravated by Finkelstein’s test.

INVESTIGATIONS

X-ray may verify the fracture but undisplaced fractures are common and can easily be missed. A repeat X-ray two weeks later or MRI can help to diagnose this severe injury.

TREATMENT

A stabilising cast, brace or strapping should be applied over six to twelve weeks depending on clinical findings and healing. Surgery for screw fixation followed by six weeks’ immobilisation is sometimes required.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon and hand specialist for consideration of surgery.

EXERCISE PRESCRIPTION

Most sports can be maintained during healing subject to an immobilised wrist. Usually athletes in sports where a brace is not allowed, such as rugby or soccer, will be off for around three months. Running, cycling and water exercises (when the wound is healed after surgery) are good alternatives to keep up general fitness. Gym training can be maintained.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs and good hand function. Compare with other hand.

DIFFERENTIAL DIAGNOSES

This is a clinical diagnosis, verified by X-ray but is still often missed.

PROGNOSIS

Excellent, if treated appropriately unless avascular necrosis occurs. In such cases, repeated surgery may be necessary and the athlete can be out of competition either temporarily or permanently.

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