).
Russe et al1 described a vertical, oblique scaphoid fracture relative to the long axis of the scaphoid on an anteroposterior X-ray view. Vertical oblique fractures are rare and are considered the most unstable. In one radiographic study only one vertical oblique fracture was seen in 442 scaphoid fractures.
2The Russe classification, however, did not take into account fractures in the frontal plane. A coronal fracture cleaves the scaphoid into a volar and a dorsal fragment along the frontal axis of the scaphoid, which is 90 degrees relative to the usual fracture plane. Coronal fractures of the scaphoid are distinctly uncommon with few published reports.3-7 In the French language literature, Schernberg et al proposed a classification that did include a diagram of a trans tuberosity coronal fracture through the middle third of the scaphoid, which he classified as a type IV fracture. 8 Coronal fractures are often missed on the initial X-ray films. Our purpose is to present a case series demonstrating the variability in the types of coronal plane fractures and to propose a classification and an algorithm for treatment.
Case Series Case 1. Complete Coronal FractureA 35-year-old man presented to D. S. with dorsal wrist pain, 5 weeks following a fall onto an outstretched hand. The patient had tenderness over the dorsal aspect of the scaphoid and a painful scaphoid shift test. The initial anteroposterior (AP) X-ray showed a double contour of the proximal pole (►Fig. 1 A) but no obvious scaphoid fracture and a normal scapholunate angle on the lateral X-ray view. The scapholunate gap appeared normal at 2 mm. A computed tomographyCoronal (or frontal plane) fractures of the scaphoid are distinctly uncommon. There are few published reports of coronal fractures of the scaphoid. This fracture is often missed on the initial X-ray films. A high index of suspicion should exist when there is a double contour of the proximal scaphoid pole on the anteroposterior X-ray view. A computed tomography scan is integral in making the diagnosis. Early recognition is key in salvaging the scaphoid fracture and in preventing articular damage. Level of Evidence IV. Retrospective case series.
