Scaphoid bone fractures and treatment

The scaphoid is one of the small bones in the wrist, located on the thumb side of the wrist, in the area where the wrist bends. It is the wrist bone that is most likely to break.

 
Bone A is the scaphoid bone

The scaphoid is at the base of the depression made by the thumb tendons. Pain or tenderness in this area can be a sign that the scaphoid is injured.

A scaphoid fracture is a break in the scaphoid bone of the wrist.

Causes of scaphoid fracture

Most scaphoid fractures occur from a fall on an outstretched hand, with the weight landing on the palm. They can also occur when your wrist twists severely or is hit very hard. Scaphoid fractures often happen while a person is playing sports such as football, soccer, or basketball or during activities such as rollerblading, skateboarding, or bike riding. They can also occur as a result of a car accident or a punching incident.

Fractures of the scaphoid occur in people of all ages, including children. There are no specific risks or diseases that increase the chance of having a scaphoid fracture.

Symptoms

Pain and swelling in the wrist will usually cause a person with a scaphoid fracture to see a doctor.

Scaphoid fractures usually cause pain in the base of the thumb, with swelling in the same area. The pain may be severe when the thumb or wrist is moved or the hand grips anything. In some cases, the pain is not severe, and may be mistaken for a sprain. So, if you have fallen on an outstretched hand and your wrist hurts, be sure to see a doctor to find out if you have any broken bones as scaphoid fractures that are not treated properly can lead to long-term problems.

Other symptoms include a hard time grabbing or gripping things or moving and twisting your wrist or thumb, and bruises around your wrist.

Treatment

Nonsurgical Treatment

Nonsurgical treatment of scaphoid fractures depends on the location of the break in the bone. When the fracture is at the end near the thumb, it usually heals in a matter of weeks with proper protection using a cast as this part of the bone has a good blood supply. If the fracture is in the middle (waist) or at the part closer to the forearm (proximal pole), healing is more difficult as these areas of the scaphoid do not have very good supply of blood making them more difficult to heal. A fracture of the scaphoid in these locations may be treated in a cast.

Surgical Treatment

Surgery may be recommended when the scaphoid is broken at the waist or proximal pole. A screw or wire may be used to stabilize the scaphoid while the bone heals. After surgery, the wrist is usually placed in a cast. Even with surgery, fractures in this area can take a long time to heal. It is possible that the bone will not heal properly (nonunion) or that portions of the bone will die from a lack of a healthy blood supply (avascular necrosis).

If the scaphoid does not heal, the surgeon may consider using bone grafts to help the bone heal. Many kinds of bone graft can be used. Bone grafts may be taken from a bone in the forearm or the pelvis, or it may be manufactured. Sometimes a special kind of bone graft with its own blood supply (vascularized graft) may be used.

Cost of treatment

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