الفهرس 
Introduction
Scaphoid AnatomyOnly 14 pages are availabe for public view
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Abstract
Although one of the smallest bones in the body, the carpal scaphoid is the subject of hundreds of publications, dozens of review articles and several books. Despite much attention by the orthopaedic community, treatment of fractures of the carpal scaphoid is not without challenge and there are a number of unanswered questions. Scaphoid fractures are the most common type of hand fracture. More than 80% of carpal fractures involve the scaphoid, with the majority occurring in young men following simple falls or sports injuries . There can be substantial morbidity, time off work and loss of earnings. Traditionally, non-displaced and stable fractures of the scaphoid have been treated conservatively, but Scaphoid fractures are often hard to immobilise, as almost every motion of the hand, wrist and forearm causes movement of the bone, putting pressure on the fracture line. Different types of casts may be used, including those that are above or below the elbow. Casting may include the thumb (‘scaphoid fracture’) or no thumb (‘Colles’ fracture’). there has been considerable debate about the type of cast used, there is little evidence for the use of long-arm casts and the tradition of including the thumb has not been shown to be beneficial. Our study is a prospective series of thirty cases with acute Scaphoid fracture comparing the results of conservative treatment (Thumb Spica) and Percutaneous internal fixation by a Herbert screw via a volar approach. Blindly each and every patient grabbed a card on which either consevative management or percutaneous fixation by a Herbert screw via a volar approach was written. This experience was conducted at the Trauma Unit and Department of Orthopaedic surgery, Assiut University Hospitals from October 2014 to December 2015. We had fifteen patients in the conservative group and another fifteen in the operative group. Of those “15” patients in the conservative group , twelve (80 %) were males and three (20%) were females and of the fifteen patients included in the operative group fourteen(93.3 %) were males and one(6.7%) patient was a female. The age of the patients ranged from 18 to 45 years in both groups and the mean age was 29.27 years in the conservative group and 31.2 years in the operative group. The majority of the patients were between 20-40 years (73.3 %)that is the productive age group. Out of 15 patients in the conservative group , we had (13) Right and (2) Left injured hands and out of the fifteen patients in the operative group we had (11) Right and (4) Left injured hands, 8 non-dominant hands and 22 dominant hand injury. In our series, the mechanism of injury was Fall on the ground in “13” patients (43.3%), Fall on the outstretched hand in “11” (36.7%), Motor bike accident in “4” (13.3%) and motor car accident in “2” (6.7%). We had 14 patients with type B2 Herbert classification scaphoid fracture and 1 patient with type B3 fracture in the conservative group and the same in the operative group so we finally had twenty eight patients with B2 type fracture and two patients with type B3 fracture. Methods and Operative techniques The patients were admitted to the trauma unit, Assiut University Hospitals. After history taking, a thorough general and local examination was performed. Plain X-ray examination and other radiological modalities were performed as required according to patient situation The mean time from trauma till casting was 13.73 hours, Range(1 hour to 2 days),while the mean time from trauma till surgery was 3 days(72.8 hours) with range 12 hours to 7 days. Conservative Treatment A short arm Thumb Spica is applied with the wrist in 20 degrees dorsiflexion and radial deviation and the Thumb abducted.The cast extends from proximal one third of the forearm to just distal to the tip of the distal phalanx of the thumb Operative Treatment Percuteaneous internal fixation by a Herbert screw via a volar approach under Regional or General anaethesia. The total operative time in our series ranged from 30 minutes to 90 minutes with mean operative time 66 minutes. Early Postoperative Care: • Well padded dressing done with limb elevation to decrease pain and edema • Patient were encouraged for early active range of motion as patient can tolerate pain and under cover of physiotherapy started as soon as possible (2nd- 3rd day postoperative) • Intravenous antibiotics (first generation cephalosporins) were used for 48 hours, followed by short course (3-4 days) of oral antibiotics (first generation cephalosporins). • Postoperative plain X-rays were done for all patients to assess the fracture reduction • Stitches were removed at 12-14 days post operatively. Late Postoperative Care: Timing After 1.5 months and 3 months postoperatively. Methods of evaluation: 1.Clinical evaluation of union : clinical signs include painless free active range of motion, absence of local tenderness in the fracture site. 2. Radiological Evaluation: identify trabeculae crossing the fracture line or sclerosis at the fracture line on Anteroposterior view Lateral view Carpal Box Radiography CT scan after 3 months:sure sign of union is the presence of crossing bony trabeculae. Nonunion may be defined by radiographic signs that are consistent with a failure of the fracture to heal (i.e., sclerosis, cyst formation, collapse, and bone resorption 3.Functional Evaluation: a) Range of Wrist motion(ROM): Measurement of range of wrist motion is done using a goniometer. Typically Recorded as Extension/Flexion e.g. 25/45 degrees, Radial deviation/Ulnar deviation e.g. 15/15 degrees b)Grip strength Measured using a sphygmomanometer cuff.