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腕舟骨骨折的康复指南
Scaphoid Fracture of the Wrist&&腕舟骨骨折&&&&&&&&&&&&&&&&&&&&&&&&& & & & & & & & && Modified by hua chen, M.D., PLA General hospital &&&&&& The scaphoid is one of the small bones in the wrist. It is the wrist bone that is most likely to break.
The scaphoid is located on the thumb side of the wrist, in the area where the wrist bends.The scaphoid is located at the base of the thumb, just above the radius bone. It can most easily be identified when the thumb is held in a
&hitch-hiking& position. The scaphoid is at the base of the hollow made
by the thumb tendons. Pain or tenderness in this area can be a sign that
the scaphoid is injured.CauseA scaphoid fracture is usually caused by a fall on an outstretched
hand, with the weight landing on the palm. The end of one of the forearm
bones (the radius) may also break in this type of fall, depending on
the position of the hand on landing.
Fractures of the scaphoid occur in people of all ages, including
children. The injury often happens during sports activities or a motor
vehicle accident. Men aged 20 to 30 years are most likely to experience
this injury.
There are no specific risks or diseases that increase the chance of
having a scaphoid fracture. Some studies have shown that use of wrist
guards during activities like inline skating and snowboarding can
decrease the chance of breaking a bone around the wrist.
SymptomsScaphoid fractures usually cause pain and swelling at the base of
the thumb. The pain may be severe when you move your thumb or wrist, or
when you try to grip something.
Unless your wrist is deformed, it might not be obvious that the
scaphoid bone is broken. In some cases, the pain is not severe, and may
be mistaken for a sprain.Any pain in the wrist that does not go away within a day of an
injury may be a sign of a fracture. A simple &sprained& wrist is very
rare and it is important to see a doctor if pain persists.Examination and TestsPain and swelling in the wrist will usually cause a person with a scaphoid fracture to see a doctor.
X-rays can show if a bone is broken and whether there is
displacement (a gap between broken bones). Sometimes, a broken scaphoid
does not show up on an x-ray right away. If this is the case, your
doctor may put your wrist in a splint for a week or two. A new x-ray
will be taken to see if the fracture will become visible. The splint
should be worn during this waiting period, and heavy lifting should be
A magnetic resonance image (MRI) scan may be taken to visualize the
bones and soft tissues. This sometimes shows a fracture of the scaphoid
before it can be seen on an x-ray.Nonsurgical Treatment
Treatment of scaphoid fractures depends on the location of the break in the bone.
Fracture Near the ThumbScaphoid fractures that are
closer to the thumb usually heal in a matter of weeks with proper
protection. This part of the scaphoid bone has a good supply of blood,
which is necessary for healing.
Your doctor will place your arm and hand in a cast. The cast will
usually be below the elbow. It may or may not include the thumb.
The time it takes for the fracture to heal varies from person to
person. Your doctor will monitor the healing by taking periodic x-rays
or other imaging studies, such as a computed tomography (CT) scan. These
imaging studies are used to confirm that the bone has healed.
Fracture Near the ForearmIf the scaphoid is broken in
the middle of the bone (waist) or closer to the forearm (proximal pole),
healing is more difficult. These areas of the scaphoid do not have a
very good blood supply.If your doctor treats this type of fracture with a cast, the cast
will probably include the thumb. It may extend above the elbow, as well.
Surgical Treatment
If your scaphoid is broken at the waist or proximal pole, your
doctor may recommend surgery. During surgery, metal implants—such as
screws and wires—are used to hold the scaphoid in place until the bone
is fully healed.Where your doctor makes the surgical incision, and how large it is
depends on what part of the scaphoid is broken. The incision may be on
the front or the back of the wrist.
Sometimes, the screw or wire can be placed in bone fragments with a
small incision. In other cases, a larger incision is needed to ensure
that the fragments of the scaphoid line up properly.
In cases where the bone is in more than two pieces, a bone graft may
be needed to aid in healing. &A bone graft is new bone that is placed
around the broken bone and is used to stimulate bone healing. It
increases bone production and helps broken bones heal together into a
solid bone.This graft may be taken from your forearm bone in the same arm or, less frequently, from your hip.(Left) This x-ray shows a scaphoid fracture fixed in place with a screw. &(Right) This x-ray was taken 4 months after surgery. The fracture of the scaphoid is healed.RecoveryWhether your scaphoid fracture requires surgery or not, you will
need to wear a cast or splint while the fracture heals. This may be for
as long as 6 months. During this period of healing, unless approved by
your doctor:Avoid heavy lifting, carrying, pushing, pulling, or throwing with the injured armDo not participate in contact sportsDo not climb ladders or treesAvoid activities with a risk of falling onto hand (for example, inline skating, jumping on a trampoline)Some people have wrist stiffness after scaphoid fractures. This is
more common when a cast was needed for a long time or when the fracture
required more extensive surgery.
It is very important to maintain full finger motion throughout the
recovery period. Your doctor will provide an exercise program, and may
recommend hand therapy to help you regain motion and strength in your
Even with therapy, some people do not recover the same motion and strength in their wrists that they had before their injuries.
ComplicationsNonunionsA bone that fails to heal is called a nonunion.
Nonunions are more common after scaphoid fractures because blood supply
to the scaphoid bone is poor. Blood supply to the bone is very
important in its healing. Bones need blood to carry oxygen and nutrients
to the site of the fracture.
If the scaphoid does not heal, your doctor may consider surgery to
apply a bone graft. &As mentioned above, many kinds of bone graft can be
used. A bone graft may be taken from a bone in the forearm or the hip,
Sometimes a special kind of bone graft with its own blood supply
(vascularized graft) may be used.
Avascular NecrosisWhen the scaphoid is broken,
especially when the fragments have moved apart (displaced), the blood
supply to those fragments may be disrupted. Sometimes, the blood supply
to one of the fragments is so poor that the piece does not get enough
nutrients and the cells in that fragment die. This is called avascular necrosis. A bone graft with its own blood supply (vascularized graft) is the most effective treatment for this condition.
ArthritisOver time, nonunion and
avascular necrosis of the scaphoid can lead to arthritis of the wrist.
Symptoms of arthritis in the wrist that results from scaphoid nonunion
or avascular necrosis include:
Aching in the wristDecreased range of motion of the wristPain with activities such as lifting or grippingIf x-rays show arthritis in the wrist as a result of an old break in
the scaphoid, treatment focuses on improving the symptoms of arthritis.
At first, this may include taking anti-inflammatory medicine and wearing
a splint when the wrist is painful. Sometimes, the doctor may inject a
steroid into the wrist to help relieve wrist pain.
If this does not work, surgery may be recommended. Many types of operations can be performed for wrist arthritis.
New DevelopmentsSome orthopaedic surgeons are placing a screw in the scaphoid
through a very small incision —about 1/4- to 1/2-inch long. The smaller
incision may decrease the chances of long-term stiffness in the wrist by
decreasing the time that a full-time cast needs to be worn. This
procedure is done using a special x-ray machine during surgery to help
guide the placement of the screw.& In addition, inserting a tiny camera (arthroscope) to look directly
at the fracture may help with the fixation of the bone and &speed
healing.There is a lot of research being done on the best way to treat
scaphoid fractures that are not healing well. Some of this research
investigates different types of bone graft, including grafts that
include their own blood vessels (vascularized grafts). Bone graft
material can be mixed with special substances (Bone Morphogenic Protein
or BMP) which improves its healing qualities.Research also involves new
wrist braces to help prevent injury, and new imaging methods that may
lead to earlier diagnosis of these difficult fractures.Last reviewed: May 2010AAOS
does not endorse any treatments, procedures, products, or physicians
referenced herein. This information is provided as an educational
service and is not intended to serve as medical advice. Anyone seeking
specific orthopaedic advice or assistance should consult his or her
orthopaedic surgeon, or locate one in your area through the AAOS
program on this website
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骨科分类问答工伤评残不属于医疗范畴！最好让法医、劳动仲裁部门决定~
舟状骨骨折占腕骨骨折71.2%，多在舟状骨腰部发生，占舟状骨骨折的70%，舟骨结节及舟骨近端骨折各占10~15%。多见于青年患者，儿童罕见。处理舟状骨骨折的方法不一，但总的方针是根据临床制订治疗方法。但是应注意，舟状骨骨折后，腕部即不稳定月状骨常向背侧屈，使桡、偷、月骨的直线对位丧失，轴线呈之字形，治疗时需纠正。无移位时，用包括拇指近节的短臂石膏固定，一般固定8~12个周，有移位的复位后，在桡偏掌屈位用长臂石膏固定12~16周。舟骨不愈合率高，Ban报导，二次世界大战时为22%，London报道为10%，晚近报导为5%~10%。2/3发生在腰部骨折，1/3发生在近段骨折。但是有骨折不愈合，而无症状及腕骨高度无改变的，可不手术，仍继续保守治疗。常用的方法有：1、植骨术（bone graft）；2、桡骨茎突切除术（radial styloidectomy）；3、克氏针固定术；4、近排腕骨切除术，但是效果不满意，已不常用；5、加压螺钉固定术。舟状骨近侧1/3骨折，如骨折伴有腕骨不稳定，则做腕骨局部融合术。远1/3骨折（结节部骨折）少见，用短臂石膏托固定3~4周即可。垂直性骨折，用立体断层法才能发现，石膏托固定4~8周。舟状骨不愈合且有创伤性关节炎时，可作舟状骨置换术，但退行变范围广，腕骨不稳定时不能用此法。
您的举报已经提交成功，我们将尽快处理，谢谢！
骨折有个愈合时间，不能操之过急！各自人的自身状况不同，所以骨折的时间也千差万别。俗话说“伤筋动骨一百天”也不是像楼上那个“大明白”所说得那样要半年以后才可以，“...
X线平片是诊断腕骨坏死的基本方法，在X线片上腕骨坏死早期骨质正常或仅见骨小梁模糊和散在骨质疏松，病情进一步发展可见局部囊性变，骨纹理稀疏，骨小梁中断紊乱或见小...
你好，舟状骨骨折本身就很难愈合的，如果骨折没有愈合，以后用力活动手腕会疼痛不适的，需要手术的
答: 正常的吧,主要是看b超推测出的孕周和实际孕周一致不
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什么是腕舟骨骨折
部分患者可能会出现：
癌肿转移至骨骼时可引起局部疼痛，其疼痛特点为由间断性逐渐变为持续性，呈进行性加剧，后期也可出现病理性骨折。
搬运体现：原发性肝癌可搬运至肺、骨、胸膜、胃肠及淋巴结等。根据搬运的部位可导致相应的体现，如肺搬运可呈现胸痛咯血等，骨搬运可呈现部分痛苦和病理性骨折等。
您好，治疗方法：新鲜骨折:新鲜舟骨骨折，或者超过一个月以上骨折，治疗原则是严格固定。一般采用短臂石膏管型。固定范围从肘下至远侧掌横纹，包括拇指近节指骨。固定中坚持手指功能锻炼，防止关节强直。腰部骨折固...
您好，症状体征：症状。伤后局部肿胀，疼痛，腕关节活动受限并疼痛加重，鼻咽窝处及舟骨结节处有压痛，第2，3掌骨头纵向叩击痛。诊断：询问伤情 包括受伤原因，时间，地点，受伤时身体姿势及何部先着地，如有创口...
你好，腕舟骨骨折为病名。是指以腕部外侧疼痛，活动受限，腕背伸、桡偏时疼痛加重，阳溪穴部肿胀、压痛明显，令患者握拳，叩击第二、三掌骨头部时，患处有纵轴叩击痛为主要表现的骨折。
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擅长疾病：严重创伤救治、复杂骨盆及髋臼骨折、四肢关节内骨折、老年骨质疏...
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擅长疾病：颈椎病、脊椎病、股骨头坏死及各种骨科疑难杂症治疗
粉碎性骨折
锁骨骨折占全身骨折的6%左右，多见于青壮年及儿童。...
肩胛骨突出
肩胛骨骨折(scauplar fracturr)相...
粉碎性骨折
指骨骨折是手部最常见的骨折，亦称竹节骨骨折。骨折可...
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大多角骨介于舟骨与第1掌骨之间，在轴向压力的传导上...
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