14, 15 Because inadequate imaging may contribute to this, it is important to ensure that the appropriate views are acquired to sufficiently evaluate the scaphoid and include a posteroanterior view, lateral view, scaphoid view, supinated oblique view, and pronated oblique views. The incidence of false-negative x-rays on the initial films for scaphoid fractures has been reported as high as 20 to 25%. Some of the possible physical findings include decreased wrist dorsiflexion and diminished grip strength in addition to snuffbox tenderness. The patient may note an inability to perform push-ups in addition to radial-sided wrist pain. Scaphoid fractures may also present as chronic injuries, particularly in the athlete who is reluctant to mention the injury until the playing season has ended. (A) Posteroanterior, (B) oblique, and (C) lateral views of the wrist demonstrating a scaphoid fracture with perilunate dislocation. 21.1 A 30-year-old snowboarder sustained a fall onto an outstretched hand. Other possible findings include wrist swelling and pain with axial load applied to the thumb. 13 The wrist examination following an acute injury reveals tenderness to palpation in the anatomical snuffbox and decreased wrist range of motion. Regardless of history, Rettig and Rettig advise that any contact sport athlete who presents with radial-sided wrist pain should be considered to have a scaphoid fracture until proven otherwise. The history of a sports-induced scaphoid fracture is typically consistent with an uncontrolled fall, collision, or direct blow to the wrist. 11 Although exact incidences are not known, other sports with potential high impact to the wrist such as rugby, soccer, hockey, wrestling, and baseball also place the scaphoid at risk.
9, 10 Meyers et al discuss the high risk of injury to rodeo riders secondary to axial overload during both riding and dismount, noting a 30% incidence of hand and wrist fractures in their series. 7 Nguyen and Letts reported a 6% incidence of scaphoid fractures out of 188 upper-extremity injuries secondary to in-line skating, 8 whereas the incidence of scaphoid fractures among snowboarders has been reported at ∼2%. 6 Ellsasser and Stein note that the scaphoid fractures they encountered in football players were all incurred by defensive players. A 1-year survey of hand injuries performed by the Methodist Sports Medicine Center in Indianapolis found that scaphoid fractures accounted for 19% of all fractures, with the highest occurrences in basketball and football players. 4, 5 In the athlete, scaphoid fractures have been reported most commonly in high-impact collision sports such as football, and in sports with potentially high-impact falls such as inline skating, basketball, snowboarding, and rodeo riding. Scaphoid fractures are the second most frequent upper extremity fracture following the distal radius, accounting for 11% of all hand fractures and 60 to 70% of carpal fractures. Because the sense of urgency for the high-level athlete to return to play is not present for the recreational athlete, the risk versus benefit of early return to play is very different between the two groups and should be thoroughly addressed with each patient. Last but not least, it is important to factor in the individual patient’s level of competition when developing a treatment plan. 1 In addition, the timing of the injury with regard to the athlete’s playing season may determine how quickly surgical intervention is contemplated.
BROKEN SCAPHOID BONE PROFESSIONAL
Ultimately, the utmost level of care must be provided, but several sport-specific issues should be taken into consideration when developing an appropriate treatment algorithm: (1) the potential for high impact to the wrist during play (football vs soccer), (2) the need for maintaining fine motor skills and high levels of accuracy (baseball pitcher vs football linebacker), and (3) the long-term outcome of the chosen treatment modality (skeletally immature athlete vs adult professional athlete). When treating any athlete, a balance must be maintained between providing appropriate care for the athlete as a patient and providing adequate consideration of the athlete’s career goals and needs.
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