Os scaphoïde

The scaphoide is a Os first line of the carpus whose functional role (in duet with the Os lunatum) is fundamental in biomechanics of the wrist.

Anatomy

The bone scaphoïde, or bone naviculaire, is the osseous element more proximal of the column of the inch. It is the scaphoide carpien. There is also a scaphoïde said tarsien which is located in the foot

It is articulated with:

Pathology

Osseous fracture

It is the bone of the generally fractured carpus.

Mechanism fracturaire:

The fracture of the scaphoïde is typical falls with " réception" on the hand, in particular with bicycle or in shoes.

The diagnosis of fracture is difficult to realize because the possible lesions can not be immediately visible on radiographies standards of the wrist of face and profile. One practices also a radiography with special incidences which make it possible to unroll the bone and thus to visualize more precisely the feature of fracture.

An imagery by scanner can also be prescribed if the radiological signs are not convincing.

In case of doubt, the French medical community has as a use to immobilize the wrist and before arm, with a plaster or a resin, during at least ten days, then, last this time, to remake radiographies of control.

The disadvantage of this method is to delay the cure if there does not exist fracture, but " simplement" an articular lesion or ligamentaire (distorsion for example), for which the immobilization is not recommended, but which on the contrary requires to be treated quickly in rehabilitation by a kinesitherapist.

The use of the techniques of modern medical imagery (scanner, IRM) makes it possible to raise the doubt very quickly, but their use in first authority does not form part of the current uses. One can regret it because in many cases, these techniques, certainly more expensive than traditional radiographies, would allow to avoid useless fixed assets and to decrease the consecutive expenses for the company (in particular with regard to the sick leave).

Dealt with therapeutic:

In the case of a fracture, three techniques of care are applicable:

immobilization prolonged of the wrist and the front armlever (plaster or resin) during 90 days
fixing in ambulatory surgery by percutaneous technique
screwing in traditional surgery with open sky

Indication:

The applicable techniques depend on the type of fracture and its localization on the bone.

For the not moved fractures, mainly those of the body of the scaphoïde , the percutaneous technique tends to develop. It takes place under local anesthesia, without hospitalization of the patient, and lasts approximately 20 to 30 minutes.

Its results are excellent, and the duration of consecutive immobilization is reduced to approximately two weeks (against 8 to 12 weeks without intervention).

Several hospital services currently work on the improvement of the percutaneous technique, with the use of the CAD (surgery computer-assisted), making it possible to improve the precision of the intervention.

Complications:

The fractures of the scaphoïde not diagnosed, and thus nonneat, involve complications quasi systematically in the long term, requiring " treatments then; lourds".

One thus should not hesitate to make carry out the ad hoc examinations to raise any doubt and, in the event of proven fracture, to be made well explain all the possible options of treatment, their the possible advantages and risks.

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