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Introduction
The scaphoid is one of the small bones in the wrist (carpal bones), and the one that is most likely to break. The scaphoid is a kidney shaped bone and sits below the thumb (refer to figure 1) A scaphoid fracture often occurs when a individual falls on an outstretched arm. The scaphoid which is also known as the navicular is damaged.
Scaphoid fractures account for about 60 percent of all wrist (carpal) fractures. They usually occur in men between ages 20 and 40 years, and are less common in children or in older adults. The break usually occurs during a fall on the outstretched wrist. Its a common injury in sports and motor vehicle accidents. The angle at which the wrist hits the ground determines the injury. If the wrist is bent at a 90 degree angle or greater, the scaphoid bone will break; if the angle is less than 90 degrees, the lower arm bone (radius) will break.
It has its own blood supply which is why a fracture can damage this blood supply causing delayed or no healing to the fracture. A complete loss of blood supply to the bone can cause death to the bone. This condition is called avascular necrosis (Avascular means no blood supply, and necrosis means dead.).
Often patients present with wrist pain following a fall and the x-ray does not immediately show damage to the scaphoid. Persistent pain and follow up x-rays can be required to correctly diagnose the condition.
Symptoms
The symptoms of a fresh fracture of the scaphoid bone usually include pain in the wrist and tenderness in the area just below the thumb. You may also see swelling around the wrist. The swelling occurs because blood from the fractured bone fills the wrist joint. Thin people will see a bulging of the joint capsule. The joint capsule is the watertight sac that encloses the joint.
Pain may subside, then return as a deep, dull aching and gripping anything may be painful.
Treatment
- Casting for 9 to 12 weeks. This is necessary to hold the scaphoid bone very still while it heals.
- Surgery such as screw fixation, scaphoid debridement and bone grafting.
Rehabilitation
The amount of time the patient needs to wear the cast depends on what part is fractured and whether the bones heal well. When your doctor is certain the bones have healed, the cast will be removed. The wrist will probably be stiff and weak from being in the cast.
Following the casting it is recommended to wear a wrist support and carry out wrist strengthening exercises to help strengthen and stabilize the muscles around the wrist joint.
