Hand and Wrist Injuries in Baseball: Scaphoid Fractures

Abstract

The injured scaphoid continues to be a nemesis to both the professional baseball player and his surgeon well into this new millennium. The injury gamut can extend from the simple “suspected” or “occult” scaphoid fracture with negative plain radiographs to the microtrabecular fracture or “bone bruise,” all the way to the high energy, comminuted proximal pole fracture with ischemia. The goal is to provide a prompt diagnosis with an injury-specific physical exam, scaphoid series plain radiographs, and advanced imaging with MR or CT as indicated. MRI is most useful in the early stages to rule in or rule out a fracture if the plain radiographs are negative. Once a diagnosis of a true scaphoid fracture has been established either by plain radiography or MRI in the “occult” cases, the next most important step is classification and assessment of fracture stability. CT is the most useful diagnostic imaging tool to assess fracture anatomy, architecture, comminution, displacement, angulation, and thus an overall assessment of fracture stability. Quite typically in this patient population, players usually elect to proceed with prompt definitive arthroscopic-assisted reduction and internal fixation (AARIF) without delay whether the fracture is displaced or not to shorten the overall immobilization time and thus provide for an earlier return to play (RTP).