The scaphoid, one of many small wrist bones, is most likely to break in an accident involving the arm or hand. (See distal radius fracture to learn about this type of wrist fracture, which can occur with a scaphoid wrist fracture). Read on to learn more about the scaphoid bones, and the causes, symptoms, diagnosis, and treatment of scaphoid wrist fractures.
Wrist Anatomy
The scaphoid bone is located when the wrist bends near the thumb. You can locate this bone by making the “hitch-hiking” sign with the thumb and finding the depression between the outer edge of the thumb and the raised tendon. If pain or tenderness is located here, it may indicate a scaphoid wrist fracture.
Causes of Scaphoid wrist fracture
A fall on an outstretched arm is one of the most common causes of scaphoid wrist fracture. Motor vehicle accidents and sports incidents can also cause scaphoid wrist fractures. These fractures can occur in people of all ages and health.
Symptoms of Scaphoid Wrist Fracture
Wrist pain and swelling are two symptoms most likely to compel a person to seek medical attention for a scaphoid fracture. While some scaphoid fractures cause the hand/wrist area to look deformed, a bone can still be broken without such apparent deformity.
Scaphoid fractures cause pain and swelling at the base of the thumb. Movement of the thumb or wrist can increase pain significantly.
Diagnosing Scaphoid wrist fracture
While some scaphoid fractures will show up on x-rays soon after the injury, in some cases it may take a couple weeks to show up on a diagnostic imaging test. In such a case, the doctor may decide to splint the wrist for two weeks and recommend limited use of the wrist before the repeat x-ray is performed.
An MRI test may also help a doctor to diagnose a scaphoid wrist fracture, often before the break shows up on x-ray.
Treatment of Scaphoid Wrist Fracture
Nonsurgical Treatment
The exact location and nature of a scaphoid break will often determine the best course of action regarding treatment.
Scaphoid fractures that occur at the end near the thumb often heal without surgery in a few weeks, so long as they are immobilized and protected. A doctor will often recommend a cast, which will extend from the hand to below the elbow and may or may not include the thumb. The time a person will need to wear the cast will depend on the healing process, as determined through x-rays and other imaging tests.
When the middle (“waist”) or “proximal pole” part of the scaphoid is broken, healing can be more difficult because these areas do not have as good a blood supply as the end-area fractures. However, a cast including the thumb and above the elbow may work to heal this area without surgery. In other cases, surgery may be necessary. Read on to learn more surgical treatment for scaphoid fractures.
Surgical Treatment
If the scaphoid is fractured at the waist or proximal pole, surgery may be necessary. To stabilize the scaphoid bone, screws or wires may be placed during surgery. Following surgery, a cast is often put on to give the area time to heal. A cast may be placed for up to six months, as this area can take a long time to heal.
With scaphoid fractures, more so than with many other fractures, there is an increased risk of non-union or failure of the bone to heal completely. Other complications can include avascular necrosis, or bone death, and arthritis.
If bone necrosis or non-union occur, addition surgery using bone grafts may be necessary to help the bone heal.
Symptoms of non-union and avascular necrosis include:
- Aching in the wrist
- Decreased range of motion in the wrist
- Pain with activity
While such complications are sometimes unavoidable, the best ways to allow the scaphoid to heal properly include avoiding:
- Contact sports
- Ladder and tree climbing
- Heavy lifting
- Carrying, pulling, pushing or throwing objects
- Activities with a risk of falling