What is a scaphoid fracture?
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A scaphoid fracture is a common type of wrist fracture. It usually occurs after a person attempts to break a fall on an outstretched hand, although car crashes and sports injuries can also cause this type of fracture. It’s important to receive treatment for a scaphoid fracture, in order to avoid complications.
What is a scaphoid fracture? How can it occur? What are the treatment options for this type of fracture? Do you need surgery for a scaphoid fracture?
What causes a scaphoid fracture?
There are eight small bones in the wrist, which are known as the carpal bones. The scaphoid is one of these, and it’s located at the base of the thumb. It’s shaped somewhat like a kidney bean, with a narrow middle and wider ends on either side.
When a person falls onto an outstretched and open hand, a scaphoid fracture may result. Most people instinctively act to catch themselves with their hands when they fall, which can easily cause a scaphoid fracture. It commonly occurs during high-speed sports activities like cycling, snowboarding, or rollerblading, but even a simple misstep off a curb could potentially lead to a scaphoid fracture if the hand is used to break the fall. Car crashes or other trauma to the wrist can also lead to a scaphoid fracture.
Scaphoid fractures are more common in adolescents and young adults, because they’re more likely to participate in sports activities that can lead to this type of injury. However, older adults are also at risk for scaphoid fractures, particularly if they also have osteoporosis (low bone density). It’s important to take steps to prevent falls in older people, to reduce the risk of injuries such as a scaphoid fracture.
What are the symptoms of a scaphoid fracture?
A person with a scaphoid fracture will usually have pain and swelling in the wrist, just below the base of the thumb. Activities that cause movement between the thumb and the wrist, such as pinching or grasping, will generally increase the pain. There may also be bruising around the area. Unlike certain other types of wrist fractures, it doesn’t usually cause a visible change in the shape of the wrist, although it is possible for this to occur in some cases.
However, this type of fracture doesn’t always cause significant swelling, and the pain may not be severe. This is why some people with a scaphoid fracture aren’t even aware that they’ve broken their wrist. They assume that they must have a minor injury, like a sprain. If you’ve had a wrist injury and you’re experiencing wrist pain, it’s important to see a doctor to check for a possible fracture.
Although the symptoms may strongly suggest a scaphoid fracture, X-ray images are needed to definitively diagnose this condition. Sometimes, additional imaging tests, like a CT scan or MRI, may also be performed, to give doctors a more detailed picture of the tissues in the area. The X-rays and other images allow doctors to determine how severe the break is, find its specific location within the bone, and determine whether the two sides are still sitting next to each other (a non-displaced fracture) or have become separated from each other (a displaced fracture). These factors are important in determining the correct treatment.
How is a scaphoid fracture treated?
The treatment for a scaphoid fracture depends on the specifics of the break, including the severity as well as the location. It’s important to keep the parts of the bone together in order to allow the body to heal the fracture. In addition, it’s important to ensure that the scaphoid’s blood supply remains adequate, so that it has the resources needed for healing.
In some cases, immobilizing the area will be sufficient to keep the two parts of the bone together and allow healing. This may involve a splint or a cast. Splints are usually worn for about four weeks, and are generally used for less severe fractures. Casts are usually worn for six to twelve weeks, although some people may need to wear one for longer to allow for full healing.
A cast will only be a good option if the fracture is non-displaced, meaning that the two parts of the bone are still located next to each other. In some cases, a doctor may be able to perform a closed reduction. This involves pushing or pulling on parts of your body in order to bring the two parts of the bone into alignment with each other. During this procedure, you may receive local or general anesthesia in order to prevent pain. A closed reduction can allow a fracture to be treated with a cast instead of surgery.
It’s also important to ensure that there’s a good blood supply to the area around the fracture. The part of the scaphoid that’s closer to the thumb has a better blood supply, and is more likely to heal without surgery. Fractures in other parts of the bone are more likely to need surgery, rather than being treated with a splint or cast.
Surgery for a Scaphoid Fracture
If the fracture is displaced, meaning that the two parts of the bone are separated from each other, then surgery is generally needed. Surgery may also be necessary if the break is in a part of the scaphoid that doesn’t have a good blood supply, because these areas are less likely to heal well on their own. Factors like smoking or diabetes can decrease blood flow and make it more likely that surgery will be needed for a scaphoid fracture.
Surgery for a scaphoid fracture involves placing plates, pins, screws, and/or wires to keep the parts of the bone in contact with each other. These may be placed entirely internally, or some parts may protrude through your skin. Any external hardware will be removed after the bone has healed, while those that are placed entirely internally are usually left in place, because removing them would cause further damage.
If the fracture is severe, or if it doesn’t heal well after the initial treatment, then a bone graft may be used to help stimulate healing. This involves inserting bone taken from another part of your body or from a donor, or an artificial substance, between the two parts of your bone. Plates, pins, or screws will also be placed, to keep the parts of the bone in place while new bone tissue grows.
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If scaphoid fractures are not treated, then the two parts of the bone may join back together abnormally, or the fracture may not heal at all. There can also be complications related to a lack of blood flow to certain parts of the bone, which can cause bone tissue to die. It’s important to get the right treatment for a scaphoid fracture, and to go to your follow-up visits to ensure that the bone has healed properly.
If you have experienced a fall or another injury to your wrist, and you’re having pain, swelling, or other symptoms, it’s important to seek medical attention for this. Don’t assume that you simply have a minor injury that will heal on its own. You might have an injury like a scaphoid fracture that needs treatment to heal properly.
If you need surgery for a scaphoid fracture, or if you believe that you might, Dr. Sungaran is highly trained in performing surgery on this delicate and complex area of the body. He will need to examine you, and see the results of any previous imaging studies, in order to determine what the best next steps would be. Please contact our office if you’d like to schedule a consultation.
