Office management of scaphoid fractures

A dull, deep pain in the wrist after a fall on an outstretched hand is the hallmark of a scaphoid fracture. Pain with maneuvers that stress the scaphoid can suggest fracture on physical exam. Radiographs are crucial: Determining the location, stability, and orientation of the fracture guides treatment and predicts outcome, Distal fractures and horizontally oriented fractures generally heal well and can be managed by immobilization ina short-arm thumb spica cast. Proximal fractures and vertically oriented fractures have the most morbidity, and open reduction should be considered. When prolonged immobilization is required, range-of-motion and strengthening exercises are prescribed to restore hand function after cast removal.