A scaphoid fracture is a break involving a bone of the carpus called the scaphoid. The scaphoid is located in the outer side of the wrist, between the thumb and the radius. It is called that way because it is thought to look like a boat. It also looks like a large cashew nut. This injury is notorious for not doing well, it can easily be missed or overlooked because of its subtle symptoms, and it may not heal properly as a consequence of the precarious blood supply of this bone.
A scaphoid fracture occurs more often in young and active individuals. The most common mechanism is a fall onto the outstretched hand. It can also occur during sporting activities or as a result of a road traffic accident.
The symptoms of a fractured scaphoid bone may include:
• Swelling and bruising of the wrist
• Pain with gripping
• Pain in the anatomical snuffbox
• Pain on the radial styloid
• Pain upon axial loading of the thumb
The doctor will see you, take a detailed history and perform a physical exam, with care not to cause and further pain or discomfort. If a scaphoid fracture is suspected, x-rays of the area will be ordered (usually 3-4 high quality scaphoid views). Early on your fracture may not be visible. In case of a strong suspicion, even in the setting of normal initial x-rays, you may be placed in a cast and get a follow up in 10-14 days. At that point, a scaphoid fracture will be apparent on x-rays. Alternatively, your doctor may order an CT scan, or an MRI.
Each scaphoid fracture is different. Treatment may depend on time elapsed since the injury, degree of displacement, location of the fracture (distal, waist, proximal), prior treatment failure, etc. The scaphoid bone is notorious for not healing well due to its precarious blood supply. Casting is generally a safe and effective treatment for non-displaced fractures of the waist of the scaphoid. Casting time, however, may vary from 6 to 12 weeks. Your doctor will follow you with serial x-rays until bone healing is achieved clinically and radiologically. Surgery is indicated for displaced fractures, fractures of the proximal pole of the scaphoid, or fractures that have failed to heal, or upon patient request if they want to get back to action as soon as possible (professional athletes or manual laborers). Surgery may be open or percutaneous based on the situation. If your scaphoid fracture fails to heal, you may have a scaphoid fracture nonunion. A scaphoid nonunion needs to be treated surgically, because if left alone it will lead to wrist arthritis, a condition called SNAC wrist. This condition is painful and will compromise your whole wrist. Surgery of scaphoid nonunion involves open surgical fixation with bone graft, taken locally or from your pelvis. Grafts can be either vascularized or non-vascularized, with current studies showing no significant difference. It is imperative that you quit smoking, as this compromises any chance of healing by at least 50%. Often times, a scaphoid fracture may coexist with associated injuries, such as distal radius fractures or perilunate dislocations, that will necessitate surgical treatment in the same setting.
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