Scaphoid Fracture of the Wrist

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.

It can most easily be identified when the thumb is held in a hitch-hiking position. The scaphoid is at the base of the hollow made by the thumb tendons. Pain or tenderness in this area can be a sign that the scaphoid is injured.

Cause

A scaphoid fracture is usually caused by a fall on an outstretched hand, with the weight landing on the palm. The end of one of the forearm bones (the radius) may also break in this type of fall, depending on the position of the hand on landing.

Fractures of the scaphoid occur in people of all ages, including children. The injury often happens during sports activities or a motor vehicle accident. Men aged 20 to 30 years are most likely to experience this injury.

There are no specific risks or diseases that increase the chance of having a scaphoid fracture. Some studies have shown that use of wrist guards during activities like inline skating and snowboarding can decrease the chance of breaking a bone around the wrist.

Symptoms

Scaphoid fractures usually cause pain and swelling at the base of the thumb. The pain may be severe when you move your thumb or wrist, or when you try to grip something.

Unless your wrist is deformed, it might not be obvious that the scaphoid bone is broken. In some cases, the pain is not severe, and may be mistaken for a sprain.

Any pain in the wrist that does not go away within a day of an injury may be a sign of a fracture. A simple “sprained wrist is very rare and it is important to see a doctor if pain persists.

Examination and Tests

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

X-rays can show if a bone is broken and whether there is displacement (a gap between broken bones). Sometimes, a broken scaphoid does not show up on an x-ray right away. If this is the case, your doctor may put your wrist in a splint for a week or two. A new x-ray will be taken to see if the fracture will become visible. The splint should be worn during this waiting period, and heavy lifting should be avoided.

A magnetic resonance image (MRI) scan may be taken to visualize the bones and soft tissues. This sometimes shows a fracture of the scaphoid before it can be seen on an x-ray.

Surgical Wrist Fracture Treatment

If your scaphoid is broken at the waist or proximal pole, your doctor may recommend surgery. During surgery, metal implants  such as screws and wires are used to hold the scaphoid in place until the bone is fully healed.

Where your doctor makes the surgical incision, and how large it is depends on what part of the scaphoid is broken. The incision may be on the front or the back of the wrist.

Sometimes, the screw or wire can be placed in bone fragments with a small incision. In other cases, a larger incision is needed to ensure that the fragments of the scaphoid line up properly.

In cases where the bone is in more than two pieces, a bone graft may be needed to aid in healing. A bone graft is new bone that is placed around the broken bone and is used to stimulate bone healing. It increases bone production and helps broken bones heal together into a solid bone.

This graft may be taken from your forearm bone in the same arm or, less frequently, from your hip.

source: HealthSource Library: http://healthsource.baylorhealth.com

Our scaphoid fracture patients come to us from Dallas, Plano, Frisco, McKinney, Prosper and bordering areas.

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