The extrinsic ligaments, note these ligaments may span 2 or more joints.
These ligaments are not as dense or as strong as the intrinsic ligaments. The next layer of ligaments lying more superficial than the intrinsic ligaments are the extrinsic ligaments. The most important intrinsic ligaments are the SL (scapholunate) and LT (lunotriquetral) The intrinsic ligaments of the wrist from the top right A and bottom B. Since these ligaments are inside the wrist-they are called intrinsic ligaments.
#SCAPHOID PAIN BUT NO FRACTURE SERIES#
These bones are interconnected with a series of ligaments. The eight bones of the right wrist (carpus) viewed from the front. The wrist is made up of eight carpal bones connecting the forearm to the hand.
The ligaments of the wrist are external to the wrist and internal to the wrist. The scaphoid has a particularly poor blood supply and gaining healing of this bone can be difficult-complications with treatment and healing are common. Treatment of these fractures spans from nonoperative treatment in a cast or brace to surgical management. These injuries often masquerade as wrist sprains-and initial radiographs may not reveal the fracture. These fractures are often associated with tenderness on the top of the wrist. The scaphoid (navicular) is one of the proximal carpal bones and may be injured in a fall. If a fracture is present, it will usually be apparent on repeat films because of reabsorption of bone along the fracture site.A Patient’s Guide to Scaphoid (Navicular) Fracture with Animated Surgical Video Introduction These patients should be placed in a thumb spica cast for 2 weeks and return for repeat radiography. Occasionally, patients can present with snuffbox tenderness after a fall on an outstretched hand, and will have no radiographic abnormalities. The third radiograph shows a very subtle fracture appearing as a fine, irregular lucency through the waist. The second radiograph shows a fracture appearing as an irregular lucent line through the waist of the scaphoid. The first radiograph below shows a fractured scaphoid appearing as a small break in the cortex. With healing, there is reabsorption of bone along the fracture line, making it more visible at 2 weeks.įractures of the scaphoid bone can be very subtle and even missed on the initial radiograph. If a patient has tenderness in the area of the anatomic snuffbox, but no fracture is apparent on x-ray, he/she should be immobilized in a thumb spica cast and instructed to return for repeat x-rays in 2 weeks. These can lead to chronic pain and instability of the wrist. Failure to recognize and appropriately manage these fractures can result in avascular necrosis of the scaphoid bone and/or non-union of the fracture. If displaced, they require urgent orthopedic consultation for reduction. If undisplaced, these fractures are managed with a thumb spica cast which immobilizes the wrist and the thumb. The scaphoid bone is the most commonly fractured carpal bone, accounting for 50-60% of all carpal injuries. Note on the oblique radiograph that there is a lucent line representing a fracture through the waist of the scaphoid bone. There was considerable swelling and tenderness in the anatomic snuffbox. This 35 year old female patient fell from her bike and suffered a hyperextension of her wrist.
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