Bilateral Simultaneous Fracture of the Carpal Scaphoid Successfully Treated with Conservative Cast Immobilisation: A Case Report

Abstract

BACKGROUND: The scaphoid is the most prominent of the carpal bones in the first row and the most frequently fractured of all the carpal bones. Bilateral simultaneous scaphoid fractures are uncommon. OBJECTIVE: To report bilateral simultaneous fractures of the carpal scaphoid bones and their successful treatment with bilateral thumb spacia casts METHODS: A 28-year-old medical practitioner presented with a day history of painful swollen wrists following a fall on both outstretched hands. He was fully examined and had both wrists X-rayed. He was subsequently treated with bilateral below elbowthumb spica POP cast. RESULTS: He had previously been healthy until this fall. Physical examination showed a healthy looking young man in pain. There were swelling and tenderness over both anatomical snuff boxes with assoociated limitation of movements at the wrists. X-rays revealed an undisplaced scaphoid wrist fracture and proximal pole fracture on the right and left respectively. He was successfully treated with bilateral below elbow thumb spica POP cast applied over a period of eight weeks. CONCLUSION: Although recent opinions tend to favour internal fixation for bilateral simultaneous fractures of the scaphoid bones to avoid prolonged cast immobilization and loss of man hours at work, they can be successfully treated with conservative cast immobilisation with comparatively early return to full activity. WAJM 2010; 29(6): 425-428.

Chronic wrist pain in a goalkeeper; bilateral scaphoid stress fracture: A case report

“…In a study by Terkelsen and Jepsen, the incidence of non-union was not found to be greater in patients with a removable short-arm plaster cast than in patients treated with a long-arm thumb plaster cast [13] . In contrast, Gellman et al reported that in patients to whom a long-arm thumb plaster cast was applied for 6 weeks from the beginning, union time was 3 months early [14] Kaneshiro et al showed a change of place of more than 3 mm of fracture fragments during pronation and supination in forearm short-arm thumb plaster casting in an experimental study where scaphoid fractures were created [15] . Long-arm thumb plaster casting was used for the case presented here.…”

Bilateral Scaphoid Fractures: A Systematic Literature Review

“…Fractures exhibiting discordance bilaterally based on Herbert's classification were documented in 25% of cases (n = 4). In one case (n = 1; 6.25%), a B2 fracture on the right and a B3 fracture on the left were reported [15]. In another case, an A2 fracture on the right and a B1 fracture on the left were observed [24].…”

“…In 75% of the cases (n = 12), the injury mechanism involved high-energy trauma. Specifically, 37.5% of the cases (n = 6) resulted from falls from a height [11][12][13][14]20,23], 6.25% (n = 1) were related to a traffic accident [24], 18.75% (n = 3) were associated with falls onto both outstretched hands [15,16,19], and 12.5% (n = 2) were attributed to sports-related trauma (Table 2) [1,21]. Four patients (n = 4; 25%) did not disclose specific traumatic events; instead, they reported multiple minor traumas occurring repeatedly over time, categorizing these fractures as stress fractures [17,18,22,25].…”