Stress fracture of the scaphoid combined with the distal radial epiphysiolysis.

Abstract

A stress fracture of the scaphoid combined with distal radial epiphysiolysis occurred in a 16 year old badminton player. Repeated shearing and torsional forces by excessive wrist movement from hitting a shuttle probably cause stress injuries in both the scaphoid and the distal radius. (BrJ7 Sports Med 1997;31:256-257) Keywords: stress fracture; scaphoid; distal radial epiphysis; badminton Stress fractures of the lower extremity are common and are being seen more often in athletic activities,' but those of the upper extremity are uncommon. To our knowledge there are only two published reports of stress fractures of the carpal scaphoid.' ' We report a further case of such a fracture combined with distal radial epiphysiolysis.Case report A 16 year old boy came to our clinic with diffuse pain around the right dominant wrist. He had practised badminton for three hours a day, six days a week, for the past two years. Seven weeks before his clinic visit he began to have pain in the wrist, which worsened with hitting a shuttle and improved with rest. Figure 1 Initial posteroanterior radiograph shows slightly increased bone density at the waist of the scaphoid and widening of the radial aspect of the distal radial epiphysis.Initially, he thought that he had strained a muscle and treated it conservatively by applying ice and decreasing his activity level, but there was little improvement. There was no previous history of pain or injury to the affected wrist.On physical examination the patient had tenderness over the distal radius and into the anatomical snuff box with diffuse swelling. He could actively move the wrist through a nearly full range of motion, but a forced passive dorsiflexion and volarflexion of the wrist caused increased pain over the wrist joint. A posteroanterior radiograph of the right wrist showed slightly increased bone density at the waist of the scaphoid and widening of the radial aspect of the distal radial epiphysis (fig 1). A semipronated oblique view showed a non-displaced fracture through the waist of the scaphoid with sclerotic borders and widening of the distal radial epiphysis, particularly on its radiovolar aspect (fig 2). The right wrist was immobilised in a short thumb-spica cast for eight weeks. Subsequent radiographs showed complete healing of the scaphoid fracture and a return to almost normal in both the width and the hazi- Figure 2 A semipronated oblique view shows a transverse fracture through the waist of the scaphoid with sclerotic borders and widening of the distal radial epiphysis on its radiovolar aspect.

Could this unusual scaphoid fracture occurring in a badminton player be a stress fracture?

“…Apparently, the fracture resulted from the sole repetition of violent flexion-extension movements of the wrist to hit the shutter. Inagaki and Inoue [1] have explained that because the scaphoid is a connecting rod between the two carpal rows, it is exposed to shearing and torsional forces by excessive and repetitive violent movements of wrist flexion and extension [1]. These mechanical stresses can result in bone failure and cause a fracture without any identified acute precipitating injury.…”

“…All these patients were ranked athletes (four gymnasts, one shot-putter and one badminton player) and did not recall any acute traumatic event [1][2][3][4]. Fractures in gymnasts and shot-putter were caused by repetitive loading of the wrist in hyperextension [2][3][4].…”

“…The scaphoid bone is a connecting rod between the two carpal rows and may be exposed to shearing and torsional forces by excessive and repetitive movements of wrist flexion and extension [1]. These mechanical stresses can result in bone failure and cause a scaphoid fracture without any identified acute precipitating injury.…”

Fratura do escafoide por estresse em ginasta: relato de caso

“…Apesar da alta incidência relativa de lesões, a fratura por estresse do escafoide é relativamente rara, com apenas algumas citações na literatura (1,(3)(4)(5)(8)(9)(10) . Mais raras ainda são as fraturas associadas à epifisiólise traumática.…”

Scaphoid Stress Fracture in Gymnastics Athlete: A Case Report

“…Despite the high relative incidence of injury, stress fracture of the scaphoid is relatively rare, with only a few references in the literature 1 , 3 , 4 , 5 , 8 , 9 , 10 . Rarer still are the fractures associated with traumatic epiphysiolysis.…”