Lab Studies:
None

Other Studies:
Wrist radiographs were negative for acute fracture. Case Photo #3 and Case Photo #4

Diagnostic ultrasound of the dorsal wrist revealed a dorsal capsular avulsion fracture at the proximal pole of the scaphoid. Case Photo #2 The scapholunate ligament was thickened and hypoechoic consistent with a grade 1 sprain. There was a cortical irregularity at the dorsal proximal/middle third junction of the scaphoid waist, with an overlying hematoma consistent with a scaphoid fracture. Case Photo #1

Computed tomography of the wrist confirmed a proximal pole scaphoid fracture with a dorsal scaphoid capsular avulsion fracture, felt to be in an unstable pattern. Case Photo #5 and Case Photo #6

Magnetic Resonance Imaging was subsequently obtained by orthopedic hand surgery to evaluate the triangular fibrocartilage complex. A non-displaced triquetral fracture was identified, as well as a linear perforation of the articular disc of the triangular fibrocartilage complex, tearing of the volar scapholunate ligament and volar portion of the interosseous ligament from the scaphoid attachment. Case Photo #7 and Case Photo #8


Photo Orientation:

Case Photo #1 - Axial image over the dorsal scapholunate interval demonstrated an avulsion fracture from the scaphoid side of the scapholunate ligament. Top of ultrasound image is superficial while the bottom of ultrasound image is deep. The right side of the ultrasound image is radial while the left of the ultrasound image is ulnar. The Asterisk (*) indicate the fourth dorsal compartment of the wrist. The white arrow indicates the avulsion fracture near the scapholunate ligament while the red arrow indicates the hematoma overlying the scaphoid. The triquetrum is represented by (T).

Case Photo #2 - Axial image over the dorsoradial scaphoid depicted a cortical break at the junction of the proximal pole/waist of the scaphoid. Top of ultrasound image is superificial while the bottom of the ultrasound image is deep. The right side of the ultrasound image is volar/radial. The left side of the ultrasound image is dorsal/ulnar. The white arrow demonstrates the cortical irregularity of the proximal pole of the scaphoid, consistent with a fracture. The red Arrow highlights the hematoma overlying the scaphoid fracture site.

Case Photo #5 - Axial Computed Tomography at the level of the distal scapholunate interval demonstrated a small dorsal avulsion-type fracture (white arrow) correlating to the fracture visualized on diagnostic ultrasound seen in photo 1. Bony landmarks are represented as follows: Pisiform (P), Triquetrum (T), Lunate (L), Capitate (C), Scaphoid (s), and Radius (R).

Case Photo #6 - Sagittal Computed Tomography displayed a non-displaced, obliquely oriented fracture of the proximal pole of the scaphoid (Red Arrow) correlating to that visualized on US in photo 2. The dorsal scapholunate avulsion-type fracuture is visible here as well by the white arrow correlating to photo 1. The distal radius is represented by (R), the Scaphoid by (S), Radial proximal Capitate by (C), the Trapezoid by (T), and the Fourth metacarpal by (4th MC).

Case Photo #7 - Coronal Oblique T2 Magnetic Resonance Imaging demonstrated the a fracture line, indicated by the red arrow, through the proximal pole of the scaphoid with adjacent interosseous edema . Bony landmarks are the Radius (R), Ulna (U), and the Scaphoid (S).

Case Photo #8 - Coronal Oblique T2 Magnetic Resonance Imaging of the wrist demonstrated a linear perforation tear involving the articular disc of the triangular fibrocartilage complex (red arrow) as well as a nondisplaced fracture involving the proximal aspect of the triquetrum (dashed red arrow) with associated bone marrow edema (white arrow). The Radius is indicated by (R), Ulna by (U), the Scaphoid by (S), the Lunate by (L), and the Triquetrum by (T).

Consultations:
Orthopedic Hand Surgery

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