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Abstract
Scaphoid fractures are common and have an increasing incidence. High clinical suspicion and complementary studies are required to reach the diagnosis, where the physical examination has high sensitivity but low specificity. Radiographs have a low negative predictive value and a high false negative rate, whereas magnetic resonance imaging is the study of choice due to its high sensitivity and effectiveness, in addition to detecting ligament injuries and presenting a favorable cost-benefit ratio. Computerized tomography has a similar sensibility, and has great utility in surgical planning. Herbert's classification is the most widely used and has great utility in defining treatment, which depends on the time to diagnosis, location and stability of the fracture. As surgical indications, instability, displacement greater than 1mm, proximal and oblique pole fractures stand out. Surgical management can be both volar and dorsal, with open or percutaneous technique depending on the characteristics of each case. In general terms, consolidation occurs in the vast majority of cases, being less in: displaced fractures, proximal pole fractures, delayed diagnosis fractures and smoking patients. Surgical management leads to a higher rate of complications, however they are considered minor. The case of a patient with a history of wrist trauma is presented. In the initial evaluation he presented little specific clinical data, a wrist x-ray was performed and no bone lesion was evident. However, the patient persisted with pain, so computed axial tomography was performed, and a fracture of the proximal pole of the scaphoid was diagnosed. Surgical management of the fracture was performed.
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References
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