Scaphoid tubercle fractures should be treated as a wrist sprain by a crepe bandage and early mobilisation.
All other undisplaced fractures and injuries suspected to be a fracture from clinical signs but not confirmed on x-ray, require complete immobilisation of the carpus. A cast is applied from the upper forearm to the metacarpal heads, and around the base of the thumb to below the interphalangeal joint. The wrist is held fully pronated, radially deviated, partially dorsiflexed and the thumb in midabduction.
For a confirmed fracture, the cast is retained for 6 weeks. For a suspected fracture, the cast should be removed after 10 days and the injury re-evaluated with a repeat oblique x-ray.
A wrist which is still tender or in which the fracture is still visible after 6 weeks requires a further 6 weeks immobilisation in the cast. If these signs persist after 12 weeks, either healing is delayed in which case, union can be hastened by bone grafting, or there is non-union.
For displaced fractures, management is essentially the same except that the fracture is first reduced, usually openly, and fixed with a compression screw. The carpus is then immobilised as above.
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