Scaphoid Facture

Anatomy of the Scaphoid Bone

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 and is at a high risk for fracture. A scaphoid fracture is usually seen in young men aged 20 to 30 years.

Causes of Scaphoid Fractures

Scaphoid fractures occur due to a fall onto an outstretched hand with complete weight falling on the palm. This fracture usually occurs during sports activities but may also occur during motor vehicle accidents. 

Symptoms of Scaphoid Fractures

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

Diagnosis of Scaphoid Fractures

Scaphoid fractures are diagnosed with X-rays; however, a non-displaced fracture does not show up on an X-ray when it is taken as early as the first week. Hence, your doctor will test for tenderness at the site of the scaphoid bone to detect the fracture. Your doctor will also advise you to use a splint and avoid lifting anything heavy for a few weeks and then order another X-ray to check for visibility of the fracture. Sometimes, an MRI scan or CT scan may also be ordered to confirm the diagnosis of the scaphoid fracture.

Treatment for Scaphoid Fractures

The treatment for a scaphoid fracture is based on the site of the fracture and the amount of displacement. Scaphoid fractures can prove to be a permanent disability if not treated appropriately and with full care. 

Non-surgical Treatment for Scaphoid Fractures 

Your doctor will suggest non-surgical treatment when the scaphoid fracture is not displaced. Non-surgical treatment involves immobilization of the forearm, hand and/or thumb in a cast.

Surgical Treatment for Scaphoid Fractures 

Surgical treatment will be suggested when the fracture is displaced or is present closer to the forearm. Surgery may also be recommended for nondisplaced fractures in active individuals hoping to return sooner to work or sport. In surgical treatment, an incision is made either in the front or back of the wrist. Your surgeon will typically use a screw 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) may be used to help in the healing process. 

Postoperative Care following Surgery for Scaphoid Fracture

Following surgery, your hand will be placed in a splint followed by a cast until it completely heals. You must take proper care to wear the cast until complete recovery of the fracture has occurred. Until then, you will be advised by your doctor to avoid contact sports and not to lift, throw, push or pull heavy weights with the injured arm. It is also very important to maintain complete motion of the fingers. During recovery, you will be advised physical therapy and taught certain exercises to help you regain strength and range of motion in your wrist and hand. 

Recovery after Treatment for Scaphoid Fracture

The time taken for the fracture to heal ranges from 6 to 12 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.

Complications of Surgery for Scaphoid Fracture

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. Bone grafting and additional fixation may be used to overcome this complication.
• Avascular necrosis: This is a complication in which the 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. Treatment with a vascularized bone graft may be suggested by your doctor 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 splints, anti-inflammatory medications, steroid injections or further surgery.