Scaphoid Fractures
A scaphoid fracture occurs when there is a break in the wrist's scaphoid bone, a small bone near the base of the thumb. The scaphoid bone has a limited blood supply and is one of the most important bones in the wrist.
Scaphoid fractures are one of the most common types of wrist fractures. They can result from a fall or other high-impact event. A scaphoid fracture can lead to significant wrist pain, arthritis, and motion loss if improperly treated. The fracture location and the presence of fracture displacement often determine whether surgery is required to treat the injury.
What You Need to Know About Scaphoid Fracture
What Is a Scaphoid Fracture?
The wrist consists of the radius and the ulna—the two bones at the base of the forearm—and two rows of four carpal bones at the bottom of the hand. The scaphoid bone is the carpal bone located above the radius on the thumb side.
A scaphoid fracture occurs when the scaphoid bone cracks or breaks into multiple pieces. Doctors often assess the severity of a scaphoid fracture based on:
The break location: Fractures can occur on the scaphoid bone's distal pole, waist, or proximal pole. The distal pole is closest to your hand, the waist is the bone's middle section, and the proximal pole is the end closest to your forearm. The majority of scaphoid fractures occur in the waist.
Severity of displacement (how far the bone pieces have moved from normal position): In nondisplaced fractures, the bone fragments have not moved from normal position. In displaced fractures, the bone fragments have moved, possibly leaving gaps or overlapping fragments.
Find out how the expert hand and wrist physicians at Resurgens Orthopaedics can provide you with world-class treatment. Schedule an appointment at one of our Metro Atlanta locations now!
What Causes Scaphoid Fractures?
Scaphoid fractures typically result from an impact that forces the wrist to hyperextend and rotate toward the thumb. Common causes include:
Falling on an outstretched hand
Collisions during sports
Car accidents
Protective gear, such as wrist guards, can protect the wrist while skating, skateboarding, and snowboarding.
Scaphoid Fracture Symptoms
Patients may mistake a scaphoid fracture for a wrist sprain because both cause pain, swelling, and grip weakness. A key difference is that the pain for a scaphoid fracture occurs on the wrist's thumb side, in the hollow made by the thumb's tendon - also known as the "anatomic snuffbox." The pain may intensify when moving the thumb or gripping an object.
If the fracture is displaced and bone fragments move from their normal position, you may feel a painful crunch, pop, or shift when moving your wrist.
Quickly diagnosing and treating a scaphoid fracture can prevent long-term complications, so it is critical to contact a hand and wrist physician if you experience any of these symptoms.
How is A Scaphoid Fracture Diagnosed?
Your doctor will complete a physical exam to determine the precise location of your pain. Because scaphoid fractures resemble sprained wrist injuries, your doctor will likely use an imaging test, such as an X-ray, MRI, or CT scan to confirm the problem.
Each imaging test will show your doctor:
The severity of the break
The location of the break
Any damage to the muscle and connective tissue around the bone
During follow-up exams, your doctor will complete more imaging tests to assess the injury's progression.
Scaphoid Fracture Treatment
The location of the break and severity of the bone's displacement will determine treatment options. Nondisplaced scaphoid fractures near the distal pole (closer to the hand) will often heal on their own if placed in a cast. Your doctor may recommend surgery if the break occurred at the waist or proximal pole (closer to the forearm) of the bone or if there are displaced fragments of the bone.
Non-Surgical Treatment
Nondisplaced scaphoid fractures near the distal pole (closer to the hand) can heal on their own if immobilized and protected. The distal pole receives good blood supply that promotes healing. Your doctor may fit you for a cast or splint to immobilize your thumb, wrist, and forearm, and healing time can range from three to eight weeks depending on the location and severity of your specific injury.
More severe breaks can also be treated by a closed reduction to realign or set the scaphoid bone. Closed reduction is a non-surgical procedure in which your doctor will move the bone to its proper place. Patients receive a local anesthetic, sedative, or general anesthesia to prevent pain. You will also need a splint or cast after this procedure.
During follow-up appointments, your doctor will assess the bone's progress by taking additional X-rays or other imaging tests.
Surgical Treatment
Displaced scaphoid fractures at the waist or proximal pole may require surgery. The waist and proximal pole do not receive good blood flow, which makes healing more difficult. Your doctor will also need to realign displaced bone fragments, so the bone heals properly.
Depending on the severity of the break, you may need one of the following surgical procedures:
Reduction: Reduction requires your doctor to make an incision and guide the bone back into position.
Internal Fixation: Internal fixation requires your doctor to hold the scaphoid in place with metal implants - pins, plates, screws, wires - until the bone heals.
Bone Graft: Bone grafting requires your doctor to insert additional bone tissue to stimulate bone production at the site of the break.
If you have injured your wrist or have any questions about scaphoid fractures, schedule an appointment with a hand and wrist specialist at Resurgens Orthopedics today!