Description:A scaphoid fracture is a break to one of the small carpal bones that makes up the wrist. The scaphoid is located on the thumb side of the wrist in an area known as the anatomical snuffbox, and is important for the motion and stability of the wrist joint. Injury to the scaphoid typically occurs after a fall onto an outstretched hand. Symptoms typically include pain and tenderness in the anatomical snuffbox and may worsen when you try to pinch or grasp something, however the pain is often mistaken as wrist pain.
Scaphoid fractures are classified based on the severity of displacement
- Non-displaced: Bone fragments remain in line with one another.
- Displaced: Bone fragments have moved out of their normal position (gapping or overlapping).
Symptoms
- Pain & swelling in the anatomical snuffbox
- Tenderness
- Bruising
- Loss of motion
- Symptoms may worsen with pinching and grasping
Causes
- Falling on an outstretched hand
- Crushing trauma
- Direct blow (sports injury, auto accident, punching something)
Risk Factors
- Can occur in people of all ages, including children.
- There are no diseases that make you more susceptible. High-energy activities (for example: snowboarding, gymnastics, inline skating, skateboarding, jumping on a trampoline)
Prevention
- Wrist guards during high-energy activities can reduce your chance of breaking a bone around the wrist.
- Avoid falls by being aware of surroundings and moving cautiously.
Diagnosis
- Your doctor will discuss your symptoms, review your medical history, and perform a thorough physical examination of your wrist and thumb.
- An X-ray will identify the type and severity of the fracture.
- Sometimes a scaphoid fracture does not show up on an x-ray right away. Your doctor may recommend that you wear a wrist splint or cast for 2-3 weeks, avoid activities that might cause further injury, and then return for a follow up x-ray if he or she suspects that you have a fracture, but it is not visible on x-ray. In many cases, scaphoid fractures become visible on x-ray only after a period of time.
- CT scan: If a fracture is suspected but did not appear clearly on an x-ray, a CT scan can also be per formed. CT scans will also show surrounding soft tissues and blood vessels.
- MRI: A MRI can be performed to identify small fractures and associated ligament injuries.
Treatment
Persistent pain in your wrist may be a sign of a fracture. Prompt diagnosis and treatment of a scaphoid fracture is key and will help avoid potential complications.There are non-operative and surgical treatments options for scaphoid fractures, depending on the fracture's severity and location on the bone. Unfortunately, complications with the healing process are common as portions of the scaphoid have a poor blood supply, and a fracture can further disrupt the flow of blood to the bone.
The treatment your doctor recommends will depend on
- The location of the break in the bone
- Closer to the thumb (distal pole) has good blood supply
- The middle of the bone (waist) and closer to the forearm (proximal pole) have poor blood supply
- If the bone fragments are displaced.
- When your injury occurred.
Fracture near the thumb:
- Cast or splint that covers your forearm, hand and thumb.
- NSAIDS
- Periodic x-rays will be used to monitor your healing and ensure that the bones have not shifted.
Fracture near the forearm
- Healing in this area can be more difficult because the blood supply is poor.
- Cast may include the thumb and extend above the elbow for better stabilization of the fracture.
Bone stimulator: Small device that delivers low-intensity ultrasonic or pulsed electromagnetic waves that stimulate bone healing.
Home exercise program and hand therapy to restore range of motion and strength in the forearm, hand and thumb once the cast or splint is removed.
Goal
Ensure proper healing while avoiding complications.
Complications
- Nonunion: bone fails to heal
- Avascular Necrosis: Cells in the blood die due to lack of nutrients
- Arthritis
Outcomes/recovery
- Slow healing
- Cast or splint for up to 6 months or until the fracture has healed.
- Maintaining full finger motion during recovery is essential to the healing process.
- Avoid the following activities (unless instructed otherwise by your physician):
- Lifting, carrying, pushing, or pulling more than one pound of weight
- Contact sports or activities with a risk of falling onto your hand
- Throwing with your injured arm
- Climbing trees or ladders
- Utilizing heavy or vibratory machinery
- Smoking
- Wrist stiffness after a long period of casting or extensive surgery.
- Some patients may not regain their full range of motion and strength, regardless of hand therapy efforts.
