Scaphoid fracture
The scaphoid bone (also called the navicular bone) is one of eight small bones in the wrist. The scaphoid is a boat-shaped bone that sits below the thumb and is one of the most frequently broken/fractured bones of the wrist. It has very small vessels that bring blood and nutrients to the bone. Because the bone does not have a strong blood supply, it can be difficult for the body to heal a fracture in this location. Early treatment is needed to ensure that the bone heals properly.
How it occurs
Scaphoid fractures typically occur when a person falls onto an outstretched hand.
Signs and symptoms
Scaphoid fractures can lead to wrist pain that is worse with gripping or squeezing or twisting of the arm. Pain may also be present in the triangle shaped sunken area of the wrist just below the base of the thumb. The scaphoid bone lies at the bottom of this area. There is often swelling and bruising in this region.
Diagnosis
Your physician will perform a careful physical exam to look for tenderness over the area of the scaphoid bone. Your physician will most likely obtain x-rays of the wrist; x-rays often show a crack in the bone. However, it may be difficult to see the fracture on x-ray initially. In many cases, follow-up x-rays are needed about two weeks after the initial injury. Even if the first set of x-rays doesn’t show the crack in the bone, the second set of x-rays may show a new layer of bone the body is producing to heal the fracture. If the wrist remains sore but there is no fracture seen on x-ray, your physician may recommend a magnetic resonance imaging (MRI) scan or bone scan of the wrist to look for a subtle fracture or bruising of the bone.
Treatment
The most important step in treatment is to immobilize the thumb with a cast or splint so that the scaphoid isn’t irritated when the thumb moves. In cases where there is significant swelling right after injury, a temporary splint is placed to prevent wrist and thumb motion. Ice can be applied and the wrist should be elevated to reduce swelling. A cast can be applied once the swelling has resolved. If the scaphoid bone is still in correct position, the bone will usually heal well with casting. The cast should cover part of the thumb and may extend above the elbow. Scaphoid fractures generally take at least six weeks to heal.
If the pieces of the scaphoid bone are out of proper position, your child may need referral to an orthopedic surgeon for surgical treatment. Surgery is also needed if the bone does not heal properly with casting. Surgical treatment is usually with a small screw or small pins to hold the bone together in the proper position. A bone graft may also be needed to promote bone healing.
Return to activity and sports
Once the cast treatment or surgical correction is complete, your doctor may recommend physical or occupational therapy. The therapy will strengthen the hand, wrist and forearm and help improve stiffness. The length of physical therapy depends on the severity and location of the fracture.
Individuals with scaphoid fractures may safely return to activity when the following is true:
- They have full wrist range of motion without any pain
- They recover wrist and hand strength
- There is no wrist pain at rest
Prevention
Scaphoid fractures and wrist injuries can be prevented by wearing wrist protection during sports activities such as roller blading or ice skating where there is a high risk of falling onto an outstretched hand.