Scaphoid Fracture

The scaphoid is a small bone located on the thumb side of your wrist. The scaphoid is unique in that it spans the two rows of bones that make up your wrist. Because of its position, it is the most commonly broken bone in the wrist.

Unfortunately, the blood supply to the scaphoid is somewhat unusual, and this can lead to problems in fracture healing.

A scaphoid fracture most frequently results from a fall on an outstretched hand. Motor vehicle crashes and sports injuries can also cause scaphoid fractures. The outcome of scaphoid fractures is largely dependent on the location of the break in the bone and the amount the bone fragments have displaced or shifted. Fractures near the end of the bone toward the handhave the greatest blood supply and heal the best. Fractures located in the middle of the scaphoid (the waist) or closer to the forearm (the proximal pole) sometimes have trouble healing because the blood supply to these areas is poor.

A scaphoid fracture causes tenderness directly over the bone. This is an area known as "the anatomic snuffbox." Your pain may increase when you move your thumb or grip things. Your initial pain may decrease over days or weeks. Scaphoid fractures usually do not cause bruising or significant swelling, which is the reason they are often mistaken for a sprained wrist.

Your doctor can diagnose a scaphoid fracture by examining your wrist and taking xrays. Sometimes scaphoid fractures do not show up on initial X-rays. The X-rays may be repeated later, or computed tomography (CT) scans or magnetic resonance imaging (MRI) scans may be used because they show more detail. CT scans are frequently performed, as the degree of fracture displacement is often difficult to determine from plain xrays.

Treatment depends on the location, fracture type, and fracture location in the bone. Fractures located near the thumb (distal pole) heal well with casting. Fractures in areas with a poor blood supply and displaced fractures generally require surgery.

Surgery for scaphoid fractures can be done through a tiny incision when the bone fragments do not need to be reduced (manipulated). Otherwise, a relatively small incision at the base of the thumb is needed. The surgical approach is determined by the fracture location in the bone. Headless screws, of which there are several types,are used to hold the scaphoid bone in position while it heals. A cast or splint is worn for some time following surgery.

It can take a scaphoid fracture a few months to heal. You will participate in hand therapy rehabilitation when your cast is removed. You should avoid gripping and heavy lifting, as well as contact sports, until cleared to do so by your doctor.

Some scaphoid fractures have a difficult time healing. There can be delayed healing, or sometimes the bone will not heal, leading to a nonunion. In these cases, follow up surgery may be necessary to insert bone grafts. The bone grafts promote healing because they either bring a blood supply to the area, or growth factors that enhance healing.

You can prevent scaphoid fractures with fall prevention techniques. If you participate in sports, you should wear protective equipment such as wrist guards made for skateboarding, inline skating, and snow boarding.

Treating underlying medical conditions can help prevent falls. A general physical examination can identify medical conditions that cause balance disorders or dizziness. An early diagnosis may allow for optimal treatment.

It can be helpful to have an occupational therapist, a physical therapist, or a family member help you examine your home and remove obstacles that may cause you to trip. It can be helpful to install railings on steps or in your shower. Low-heeled sturdy shoes may help you maintain proper foot positioning. A cane or walker may aid your balance while you stand or walk.