Scaphoid Fracture

The scaphoid bone is a small, boat-shaped bone in the wrist, which, along with 7 other bones, forms the wrist joint.  It is present on the thumb side of the wrist causing it to be at a high risk for fractures. A scaphoid fracture is usually seen in young men aged 15 - 30 years.

Causes

Scaphoid fracture occurs due to a fall on an outstretched hand with complete weight falling on the palm. This fracture usually occurs during motor accidents or sporting activities.

Symptoms

Symptoms of a scaphoid fracture include pain and swelling at the site of injury (base of the thumb and forearm). There is often no deformity at the site of fracture, hence it may be mistaken for just a sprain. Bruising is also a very rare symptom of the fracture. There are chances that the patient might not be aware of the fracture for months or even years after the fall as the pain generally improves in a few days.

Diagnosis

Scaphoid fractures are diagnosed by X-rays. However, a non-displaced fracture is often not visible on an X-ray in the first week. Hence, Professor Bain will test for tenderness at the site of the scaphoid bone to detect the fracture. You will be placed in a splint and must avoid lifting anything heavy for a few weeks. Another X-ray, MRI scan, CT scan or bone scan will also be ordered to confirm the diagnosis of the scaphoid fracture.

Treatment

Treatment for scaphoid fracture is based on the site of the fracture i.e. the fracture near the thumb or near the forearm.

Non-surgical Treatment: Non-surgical treatment is used when the scaphoid fracture is not displaced. Non-surgical treatment involves immobilisation of the forearm, wrist in a cast. The time taken for the fracture to heal ranges from 6 – 10 weeks. Fractures near the thumb take relatively less time to heal when compared to fractures near the forearm as the blood supply necessary for healing is better near the thumb.

Surgical Treatment: Surgical treatment may be suggested when the fracture is displaced or is present closer to the forearm. In surgical treatment, an incision is made either in the front or back of the wrist. Screws and wires are used to hold the scaphoid bone in place as it heals. If the bone is broken into more than 2 pieces, bone graft (graft usually taken from the forearm or hip) may be used to help in the healing process.

Following surgery, your hand will be placed in a splint or cast until it completely heals. Until then, you will be advised to avoid contact sports and not to lift, throw, push or pull heavy weights with the injured arm. During recovery, you will be given physiotherapy and taught certain exercises to help you regain strength and range of motion in your wrist.

Complications

The diagnosis and treatment of scaphoid fractures can be complicated. The complications involved in the treatment of scaphoid fracture include:

• Non-union: when a bone fails to heal after treatment. This is caused due to limited blood supply in the scaphoid region. A special kind of bone graft called a vascularised graft, in which the bone has its own blood vessels, can be used to reduce this complication.
• Avascular necrosis: This is a complication in which cells of the scaphoid bone die due to lack of blood supply, causing bone collapse and arthritis. This usually happens in case of displaced fractures, as the displaced bone fails to get proper nutrients. Surgical treatment with a vascularised graft may be suggested by Professor Bain to treat this complication.
• Post-traumatic arthritis: Persistent non-union and avascular necrosis of the scaphoid can cause arthritis of the wrist. This can be treated with splits, anti-inflammatory medications, steroid injections or surgery.

Conclusion

Scaphoid fractures can prove to be a permanent disability if not treated appropriately and with full care. The patient must take proper care to wear the cast until complete recovery of the fracture has occurred. It is also very important to maintain complete motion of the fingers and avoid lifting or pushing heavy weights during the recovery period. Exercise programs and physiotherapy should be strictly followed until the same motion and strength in the wrist is restored.