Scaphoid Fracture of the Wrist
Your hands and wrists are essential tools that allow you to work, play and perform everyday activities. How well the hand and wrist interact depends on the integrity and function of the ligaments, tendons, muscles, joints and bones.
Problems in any of these can affect upper extremity function, causing disruptions at home and work and negatively impacting quality of life.
The human hand itself is very complex and delicate in structure. At some time in life, you may experience hand or wrist pain.
The scaphoid is one of the small bones in the wrist. It is the wrist bone that is most likely to break. The scaphoid is located on the thumb side of the wrist, in the area where the wrist bends.
The scaphoid is located at the base of the thumb, just above the radius bone.
It can most easily be identified when the thumb is held in a “hitch-hiking” position. The scaphoid is at the base of the hollow made by the thumb tendons.
Pain or tenderness in this area can be a sign that the scaphoid is injured.
A scaphoid fracture is usually caused by a fall on an outstretched hand, with the weight landing on the palm. The end of one of the forearm bones (the radius) may also break in this type of fall, depending on the position of the hand on landing.
Fractures of the scaphoid occur in people of all ages, including children. The injury often happens during sports activities or a motor vehicle accident.
There are no specific risks or diseases that increase the chance of having a scaphoid fracture. Some studies have shown that use of wrist guards during activities like inline skating and snowboarding can decrease the chance of breaking a bone around the wrist.
Scaphoid fractures usually cause pain and swelling at the base of the thumb. The pain may be severe when you move your thumb or wrist, or when you try to grip something.
Unless your wrist is deformed, it might not be obvious that the scaphoid bone is broken. In some cases, the pain is not severe, and may be mistaken for a sprain.
Any pain in the wrist that does not go away within a day of an injury may be a sign of a fracture.
A simple “sprained” wrist is very rare and it is important to see a doctor if pain persists.
Pain and swelling in the wrist will usually cause a person with a scaphoid fracture to see a doctor.
X-rays can show if a bone is broken and whether there is displacement (a gap between broken bones). Sometimes, a broken scaphoid does not show up on an x-ray right away. If this is the case, Dr. Backe may put your wrist in a splint for a week or two. A new x-ray will be taken to see if the fracture will become visible. The splint should be worn during this waiting period, and heavy lifting should be avoided.
A magnetic resonance image (MRI) scan may be taken to visualize the bones and soft tissues.This sometimes shows a fracture of the scaphoid before it can be seen on an x-ray.
Treatment of scaphoid fractures depends on the location of the break in the bone.
Fracture Near the Thumb
Scaphoid fractures that are closer to the thumb usually heal in a matter of weeks with proper protection. This part of the scaphoid bone has a good supply of blood, which is necessary for healing.
Your doctor will place your arm and hand in a cast. The cast will usually be below the elbow. It may or may not include the thumb.
The time it takes for the fracture to heal varies from person to person. Your doctor will monitor the healing by taking periodic x-rays or other imaging studies, such as a computed tomography (CT) scan. These imaging studies are used to confirm that the bone has healed.
Fracture Near the Forearm
If the scaphoid is broken in the middle of the bone (waist) or closer to the forearm (proximal pole), healing is more difficult. These areas of the scaphoid do not have a very good blood supply.
If Dr. Backe treats this type of fracture with a cast, the cast will probably include the thumb. It may extend above the elbow, as well.
If your scaphoid is broken at the waist or proximal pole, Dr. Backe may recommend surgery. During surgery, metal implants—such as screws and wires—are used to hold the scaphoid in place until the bone is fully healed.
Where Dr. Backe makes the surgical incision, and how large it is depends on what part of the scaphoid is broken. The incision may be on the front or the back of the wrist.
Sometimes, the screw or wire can be placed in bone fragments with a small incision. In other cases, a larger incision is needed to ensure that the fragments of the scaphoid line up properly.
In cases where the bone is in more than two pieces, a bone graft may be needed to aid in healing. A bone graft is new bone that is placed around the broken bone and is used to stimulate bone healing. It increases bone production and helps broken bones heal together into a solid bone.
This graft may be taken from your forearm bone in the same arm or, less frequently, from your hip.