Scaphoid Fracture

What is a Scaphoid Fracture?

A scaphoid fracture is a break in the scaphoid bone, a small, boat-shaped bone in the wrist, located near the base of the thumb.

The scaphoid is the most commonly fractured carpal bone, and it is more likely to occur in young children and the elderly than in the distal radius, which is relatively weaker in these age groups.

After a fall, catching oneself with outstretched arms is nearly usually the cause of scaphoid fractures. Traumas like auto accidents can also bring them on. Surgery may be necessary to fix your bone. The average recovery time from a scaphoid fracture is three months.

Anatomy of Scaphoid

The two forearm bones (ulna and radius) and eight small carpal bones, which are arranged in two rows at the base of the hand with four bones in each row, make up the wrist.

The scaphoid bone, one of the carpal bones, is located near the radius on the thumb side of the wrist. The bone affects the wrist joint’s range of motion and stability.

“Scaphoid” is derived from the Greek word meaning “boat.” The scaphoid bone’s relatively long and curved nature gives it a boat-like appearance. Because it connects the proximal row of carpal bones—the bones nearer the ulna and radius—to the distal row of carpal bones—the bones nearer the fingers—the scaphoid is particularly crucial to wrist function. The scaphoid must move easily and freely for the wrist to move as best it can.

The easiest way to identify the scaphoid bone is to hold your thumb in the “thumbs-up” or “hitch-hiking” posture. On the rear of the wrist, it is situated near the base of a groove created by the thumb tendons. Known as the “anatomic snuffbox,” this region is usually where you have the most pain or sensitivity following a scaphoid fracture.

Causes of scaphoid fracture

When you fall onto an outstretched hand and your weight relaxes on your palm, you frequently sustain a scaphoid fracture. Depending on the hand’s posture upon landing, the radius, the larger forearm bone, may also break in this kind of fall.

Sports activities and auto accidents might also result in injury.
Scaphoid fractures can occur in people of any age, including young children. You are not predisposed to scaphoid fractures due to any particular risk factors or medical conditions.

According to some research, wearing wrist protectors can help reduce the risk of shattering a wrist bone when engaging in high-intensity sports like snowboarding, skateboarding, and inline skating.

Symptoms of scaphoid fracture

• Scaphoid fracture symptoms include:
• Swelling and pain.
• sensitivity.
• You can’t move your wrist.
• discoloration or bruises.
• a lump or abnormalities that isn’t often on your wrist.

Differential Diagnosis of scaphoid fracture

The location of discomfort, pain during specific movements, and radiological anomalies can be used to distinguish between these illnesses.
fracture of the distal radius
Associated condition of the carpal bones

• De Quervain’s tenosynovitis
• Osteoarthritis
• Tendinopathy
• Scapholunate dissociation.

Physical Examination of scaphoid fracture

• Maybe we could discuss your general health.
• will inquire as to how your injury occurred.
• Asking you to explain your symptoms
• Also, your wrist will be examined by your physician. For the majority of fractures, the anatomic snuffbox will be sensitive just over the scaphoid.

Also, your physician will search for:

• Bruising with Swelling.
• loss of movement.

Investigation of scaphoid fracture

X-rays

X-rays provide views of dense structures, such as bone. In order to assess whether you have a scaphoid fracture and whether the fractured bone fragments are dislocated, your doctor will probably need an X-ray. Your doctor will use an X-ray to see if you have any further fractures or dislocations.

A scaphoid fracture may not always be immediately visible on an X-ray. Your doctor might advise you to wear a cast or wrist splint for two to three weeks before returning for a follow-up X-ray if they suspect a fracture but it is not evident on the X-ray. Scaphoid fractures frequently take awhile to show up on an X-ray.

Magnetic resonance imaging (MRI)

To find out more about the soft tissues and bones in your wrist, your doctor might prescribe an MRI. Sometimes an MRI may indicate a scaphoid fracture before an X-ray can.

CT scan (computerized tomography)

A CT scan can be useful in detecting a scaphoid fracture and determining whether the bones are displaced. The CT scan data may be used by your physician to inform your course of therapy.

Treatment of scaphoid fracture

Your doctor’s recommended course of therapy will be determined by a number of factors, including but not limited to:

• The position of the bone break
• Whether the pieces of bone are moved
• How long ago did you get hurt?
• Age and overall health.

Nonsurgical Treatment of scaphoid fracture

Immobilization period

Immobilization in a cast is a non-operative treatment option for non-displaced fractures that occur within the distal third of the bone. There is debate about whether a thumb spica should be used to immobilize the thumb or whether a long or short arm cast is better; at this time, there is no proof that one is superior to the other.

Repeat radiographs are typically done during the six weeks after immobilization in order to evaluate for the union.

• The placement of the fracture affects the time to union.
• About 90% of non-displaced or minimally displaced (≤ 0.5 mm) scaphoid waist fractures should heal in 6–8 weeks for the distal third,
• 8–12 weeks for the middle third,
• and weeks for the proximal third.

Conservative treatment is an option for scaphoid wrist fractures with mild displacement (0.5–1.5 mm), which require extended cast immobilization for eight to ten weeks.

The weak blood supply and retrograde arterial flow are secondary to the relative increase in time to healing during the distal to proximal transition.

Fracture close to the thumb

With the right care and limited activity, non-displaced scaphoid fractures nearer the thumb (distal pole) should heal. There is a healthy blood flow to this area of the scaphoid bone, which is essential for healing.

Your doctor might put a cast or splint on your hand and forearm for this kind of fracture. Your thumb will typically be included in the cast or splint, which is typically placed below the elbow.
Each patient has a different healing time. Your physician will use imaging examinations, like as X-rays, to track your recovery.

Fracture close to the forearm

Healing may be more challenging if the scaphoid is fractured (but not dislocated) near the forearm (proximal pole) or in the center of the bone (waist). As previously mentioned, the blood flow to these scaphoid regions is poor.

Your thumb and the area above the elbow may be covered by the cast if your doctor decides to use one to treat this kind of fracture. In contrast to a more distal fracture close to the thumb, you will usually need to remain in the cast or splint for a longer period of time with this kind of fracture, stimulant for bones.

In certain situations, your physician could advise using a bone stimulator to promote the healing of fractures. This little gadget emits pulsed electromagnetic waves or low-intensity ultrasonic waves that stimulate healing.

Surgical Treatment of Scaphoid Fracture

Internal fixation

Surgery is necessary for the most severe fractures. In order for your scaphoid to heal and grow back together, your surgeon will realign (set) it to its proper position and then secure it there. In order to hold your bone in place while it heals, your surgeon will typically conduct an internal fixation, which involves inserting metal pieces into your bone. Techniques for internal fixation include:

Plates and screws

To keep the parts together, metal plates are screwed into your bone.
Bone fragments too tiny for other fasteners are secured in place by pins and wires. Usually, they will be utilized concurrently with either rods or plates.

Bone grafting

If your bone isn’t growing back together as it should or if your scaphoid fracture is significantly displaced, you may need bone grafting. The surgeon will insert more bone tissue to replace the destroyed bone. To keep the fragments together while your bone heals, physicians will typically perform an internal fixation after that. There are several sources of bone grafts:
Inwards from another part of your body, typically the upper part of your hip bone. a donor from outside.

A artificial replacement

You should be able to return home the same day after a scaphoid fracture surgery, which is often an outpatient operation.
After the operation, your wrist will be immobilized. You’ll need a splint or cast before you can start using it like you did before your fracture.

Physical therapy of scaphoid fracture

Following a period of immobilization, either conservatively or post-operatively, the hand and wrist are likely to be stiff and have weaker muscles once the fracture becomes stable and the cast is taken off. Physical therapy main objectives are:

• Active range of motion (AROM) should be restored.
• Cut down on edema
• Boost wrist strength and grip
• Return to practical goals and tasks

ROM exercises

Since the hand and wrist will be stiff, active-assisted range of motion exercises should be the main focus of ROM exercises in the early stages following immobilization.

The wrist and thumb should be the main focus of these exercises, but the fingers, elbow, and shoulder also be taken into account because they may become tight following immobilization

Manual treatment in the form of joint mobilizations to the radio-carpal joint, radio-ulnar joint, and possibly the carpal joints may be helpful during the therapy session if the full range of motion is still limited.

To reduce any remaining discomfort or swelling, additional manual treatment techniques like massage or soft tissue work may be helpful.

Exercises for strengthening

Following the restoration of a full or functional AROM, wrist, and hand strengthening activities are essential.

This is an essential stage in the rehabilitation process because if the hand is not strengthened, the patient may have long-term functional limitations and be at risk for more injuries.

Restoration of function

Individualized goals and tasks should be the focus once full AROM and a good baseline strength have been recovered. Since those with scaphoid fractures are typically younger to middle-aged, they are probably active, have occupations, or have families to take care.

To achieve these objectives and goals, certain rehabilitation and exercises must be adapted to the individual.

If the fracture has been treated properly in the early stages, that is, without any remaining avascular necrosis, the full function will eventually be recovered.

Early surgical intervention has been shown to result in a quicker return to play in the athletic population, typically 6–11 weeks, as compared to conservative care, which takes 4–16 weeks.

Complications of scaphoid fracture

Nonunion

A nonunion is a bone that does not heal. Because of the limited blood supply to the scaphoid bone, nonunions are more likely following scaphoid fractures. Since blood delivers nutrients and oxygen to the fracture site to promote healing, a healthy blood supply to a bone is crucial to fracture healing.

Your doctor might think about doing another surgery to implant a bone transplant if your scaphoid fracture does not repair. Bone grafts come in various varieties.

Your doctor may use a vascularized graft, a unique type of graft with its own blood supply, for nonunions.

Avascular Necrosis

If a fracture has collapsed, your doctor might use a strong structural graft, which might be obtained from your Avascular Necrosis. The blood flow to the bone may be interrupted in scaphoid fractures, particularly when the bone fragments have moved.

One of the pieces of bone will not receive adequate nutrients, and the cells within it will die if the blood supply decreases significantly or is eliminated entirely. If this happens, the bone can’t heal correctly. We refer to this disorder as avascular necrosis.

As long as the wrist has not developed arthritis or the bone has not collapsed severely, a vascularized bone transplant might be the best course of action for this issue.

The condition of arthritis Wrist arthritis can develop as a result of scaphoid nonunion and avascular necrosis over time. When the joint’s articular cartilage breaks down and gets frayed, sometimes to the point where bone scrapes against bone, arthritis develops.

Wrist’s arthritis

The following are some signs of wrist arthritis:

• Aching
• Stiffness
• Decreased wrist joint range of motion
• Pain during weight-bearing, grasping, and lifting activities

FAQs

References

• Scaphoid fracture of the wrist – OrthoInfo – AAOS. (n.d.). https://orthoinfo.aaos.org/en/diseases–conditions/scaphoid-fracture-of-the-wrist/
• Scaphoid fracture. (2025, January 24). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22240-scaphoid-fracture