Scaphoid-Fracture-of-the-Wrist-1-1200-by-750

Summary

Causes

Fall onto an outstretched hand
Sports activities
Motorbike collisions

Symptoms

Pain and swelling at the base of the thumb
Worsens with movement of thumb or wrist

Investigations may involve

X-ray
MRI scan
CT scan in case of non-unions

Treatment

Plaster cast in case of non-displaced bone
Surgery, if the fracture is displaced, with insertion of a screw or pins

What is a Scaphoid Fracture?

A scaphoid fracture is a break in one of the small bones of the wrist. The wrist is formed by the two bones of the forearm (the radius and ulna) and eight small carpal bones. Carpal bones are arranged in two rows, at the base of the hand with four bones in each row. Scaphoid bone is one of the carpal bones on the thumb side of the wrist just above the radius. The word scaphoid comes from the Greek term meaning boat (scaphoid bone has a relatively long curved shape which resembles a boat).

What are the causes and symptoms of a Scaphoid Fracture?

It is the most frequently fractured carpal bone. It happens when you fall onto an outstretched hand. This can also happen during sports activities or motorbike collisions.

You will experience pain and swelling at the base of the thumb which will become worse when you move your thumb or wrist. Some scaphoid fractures may not be severe and could be mistaken for a wrist sprain.

Hence pain in your wrist which does not settle within a few days of injury may be a sign of a fracture and you will have to see the doctor if pain persists. Early treatment of scaphoid fracture will help avoid potential complications in the future like a non-union, avascular necrosis or arthritis to your wrist.

What will the doctor do when I see them?

He will take a history and examine your wrist. He may order investigations like an x-ray and sometimes MRI scan to assist with the diagnosis and to make a treatment plan for you. In case of non-unions he will do a CT scan to assess bones.

What does the treatment involve?

If the scaphoid is broken then the few tiny blood vessels that supply the bone with nutrients can be damaged. Because the blood supply is needed to heal a fracture the scaphoid often takes a long time to heal (2-6 months).

If the scaphoid fracture is non-displaced (bone has not moved out of place at the fracture site) then this can be treated with a plaster cast. Plaster casts are generally given for around 4-6 weeks, but it may take longer in some patients.

If the fracture is displaced (bone ends has shifted at the fracture site) or if the fracture is in a certain part of the scaphoid bone, then you will be offered surgery. Surgery normally includes the insertion of a screw or very occasionally pins.

How do you manage scaphoid non-union after a fracture?

Scaphoid non-union essentially means a fracture that is failing to heal. Treatment of a non-union will depend on many factors including age, activity level, medical conditions, cigarette or other tobacco use, fracture pattern and symptoms. The ultimate goal of treatment will be to relieve pain, give you strength and function, and prevent arthritis in the future.

Surgery will involve cleaning out the fracture site, bone graft at the fracture site to help bone healing then stabilise the fracture with a screw. If non-union is not treated, then in some patients it can lead to arthritis in the future. In my experience, surgery for non-union has few complications with very predictable results.