Scaphoid Fracture

What is Scaphoid Fracture?

A wrist consists of little bones one of which is called as scaphoid. When the break occurs in either of these little bones present in the wrists this condition is known as scaphoid fracture.

A wrist consists of eight little bones, which are located between the bones of the forearm known as ulna and radius and the bones present in the hand. The scaphoid is a bone, which lies in the gap between the radius and the thumb base.

Stress or compression could be placed on the scaphoid bone while performing certain activities like falling down on an outstretched hand. If the force is traumatic and beyond the tolerance power of the bone then this may result in breaking of the scaphoid bone resulting in scaphoid fracture.

Scaphoid Fracture

Classification and Types of Scaphoid Fracture:

Scaphoid fractures may be classified depending on various conditions. They can be classified based on their anatomic location.

  • Tubercle Fractures: These type of fractures are generally uncomplicated fractures. They are generally asymptomatic even in case of nonunion.
  • Distal Pole Fractures: These kind of fractures are commonly uneventful in nature. These type of fractures can further be classified into two categories:
    1. Fractures involving the joint with the trapezium and the trapezoid.
    2. Fractures not involving the joint with the trapezium or the trapezoid.
  • Proximal Pole Fractures: In this case, the fracture occurs at the middle of the scaphoid bone also known as scaphoid waist or closer to the forearm. Healing of such fracture is a bit difficult as these areas of scaphoid have less blood supply compared to remaining areas of the hand.

Scaphoid fractures are also classified based on the planes with respect to the long axis of the scaphoid into transverse, horizontal oblique, and vertical oblique fractures.

Causes and Risk Factors of Scaphoid Fracture:

  • A scaphoid fracture may be caused by a traumatic pressure or force on the wrist like falling down on an outstretched hand.
  • A scaphoid fracture may be caused by any kind of fall.
  • A scaphoid fracture is mostly common in sports activities like snowboarding or skateboarding, especially in icy atmosphere.
  • Scaphoid fracture may also occur in combination with the fracture of the end of the radial bone depending on the position of the hand at the time of impact.
  • Scaphoid fractures may be caused at any age be it childhood, adolescent or old age.
  • People in the age group of 20 to 30 years are more likely at a risk of scaphoid fracture.

Signs and Symptoms of Scaphoid Fracture:

  • Generally if the wrist pain does not subside within a day of an injury, it may be indicative of a scaphoid fracture.
  • Swelling and pain could also be experienced while touching firmly on the thumb side of the wrist where the scaphoid bone is located.
  • Severe pain could also be experienced during the movements of the wrist or thumb.
  • Major wrist pain may be experienced at the time of injury. The griping capacity may also get affected along with pain while lifting an object with an injured wrist.
  • Usually the pain is experienced on the thumb side of the wrist, which occasionally settles down quickly leaving behind an achiness that is more prominent at night or upon awakening in the morning.

Treatment for Scaphoid Fracture

Treatment for Scaphoid Fracture:

Treatment of scaphoid fractures depends upon the fractured portion of the bone.

Nonsurgical Treatment of Scaphoid Fracture:

Certain conditions where the fracture is incomplete or is stable without any motion at the fracture site can be treated without surgery.

  1. Scaphoid Fracture Near the Thumb: Scaphoid fractures that occur closer to the thumb generally heal within a few weeks simply with proper protection as there is good blood supply to this area of the bone. The arm and hand is placed in a cast for immobilization so that the area is well protected allowing it to heal faster. Casting generally starts from below the elbow. Healing time of the fracture differs from one individual to another depending on the body habitus. Periodic monitoring is done with the use of x-rays or CT scan to assess for the progress.
  2. Scaphoid Waist Fracture: In this case, the fracture occurs at the middle of the scaphoid bone also known as scaphoid waist or closer to the forearm. Healing of such fracture is a bit difficult as these areas of scaphoid have less blood supply compared to remaining areas of the hand. The arm and hand is placed in a cast for immobilization so that the area is well protected allowing it to heal faster. Casting generally starts from above the elbow. Healing time of the fracture differs from one individual to another depending on the body habitus. Periodic monitoring is done with the use of x-rays or CT scan to assess for the progress.

Surgical Treatment of Scaphoid Fracture

In cases where the bone is broken at the scaphoid waist or proximal pole surgery is recommended. Metal implants such as wires and screws are used to fix and hold the scaphoid in place until complete union of the fracture occurs.

A bone graft may be used if some cases where the bone is broken into two or more fragments to aid in proper healing. A bone graft is nothing but a new bone placed at the side of the fracture to stimulate healing. Bone graft increases the production of the bone and this in turn helps in speeding up the healing process of the broken bones into a solid bone.

Physiotherapy for Scaphoid Fracture:

Physiotherapy for scaphoid fracture is important in speeding up the healing process and to get optimal results. Physiotherapy also decreases the likelihood of recurrences in the future. Physiotherapy may include:

  • Soft tissue massage.
  • Electrotherapy.
  • Joint mobilization.
  • Bracing or taping.
  • Exercises to improve strength and flexibility.
  • Activity modification and training.
  • Appropriate plan for return to activity.

Exercises for Scaphoid Fracture:

Wrist Bends: This exercise is performed by placing the forearm on a table and the wrist and fingers over the edge. Bend the wrist forwards and backwards slowly until a mild to moderate pain-free stretch is felt. Repeat 10 times ensuring there is no exacerbation of symptoms.

Forearm Rotations: This exercise is performed with the elbow at the side and bent to 90 degrees. Rotate the palm up and down slowly until a mild to moderate pain-free stretch is felt. Repeat 10 times ensuring there is no exacerbation of symptoms.

Wrist Side Bends: This exercise is performed by placing the forearm on a table and the wrist and fingers over the edge. Bend the wrist from side to side slowly until a mild to moderate pain-free stretch is felt. Repeat 10 times ensuring there is no exacerbation of symptoms.

Tennis Ball Squeeze: This exercise involves holding a tennis ball in the hand and squeezing it as hard as possible ensuring comfort without pain. Hold for 5 seconds and release. Repeat 5 to 10 times ensuring there is no exacerbation of symptoms.

Tests to Diagnose Scaphoid Fracture:

A complete subjective physical examination is really important to aid with a scaphoid fracture diagnosis.

Other tests may include:

  • X-ray of the wrist.
  • CT scan in rare cases.
  • MRI in rare cases, generally if surgical treatment is required.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: August 9, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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