Scaphoid fractures: anatomy, diagnosis and treatment

This thesis deals with current issues in anatomy, diagnosis and treatment of scaphoid fractures. Anatomical inconsistencies are elucidated by accurate 3D imaging. Sophisticated diagnostic imaging cannot solve the problem of the suspected scaphoid fracture because there is no gold standard for a true fracture, and there likely never will be. Acknowledging that we can only deal in probabilities, the development of clinical prediction rules will help to better define and narrow those probabilities. Fracture displacement and instability cannot be accurately diagnosed or predicted on CT or radiographs. CT is more accurate than radiographs at diagnosing displacement, and training of observers can increase the reliability. Adequate treatment of scaphoid fractures can result in high rates of union (95-100%). The choice of surgical or conservative treatment should be based on surgeon and patient preferences. If conservative treatment is opted, there is no need to immobilize the thumb.