A scaphoid fracture of the wrist is a break in a small bone on the thumb side of your wrist. Of the eight carpal bones in your wrist, your scaphoid bone is the most likely one to break. It is important to find out if you have a scaphoid fracture, because scaphoid fractures need treatment to heal well. With proper treatment and follow-up, most scaphoid fractures will heal over time. Without treatment, and sometimes with treatment, healing can be slow and difficult because parts of the scaphoid bone do not have a good blood supply. If your scaphoid bone does not heal well, you can have long-term pain, stiffness, or arthritis in your wrist.
What causes a scaphoid fracture?
Most scaphoid fractures occur when you stretch your hand out in front of you to protect yourself from a fall. They can also occur when your wrist twists severely or is hit very hard. Scaphoid fractures often happen while a person is playing sports such as football, soccer, or basketball or during activities such as Rollerblading, skateboarding, or bike riding. They can also occur as a result of a car accident or a punching incident.
What are the symptoms?
Because most scaphoid fractures do not cause the wrist to look broken and many cause only minor symptoms, it can be hard to know if your scaphoid bone is broken. If the bone is broken, you may have:
• Pain, tenderness, or swelling on the thumb side of your wrist.
• A hard time grabbing or gripping things or moving and twisting your wrist or thumb.
• Bruises around your wrist.
It can be hard to tell the difference between a wrist that is sprained and one that is broken. If you have fallen on an outstretched hand and your wrist hurts, be sure to see a doctor to find out if you have any broken bones. Scaphoid fractures that are not treated properly can lead to long-term problems.
How is a scaphoid fracture diagnosed?
Your doctor will ask you questions about your symptoms and about how and when you hurt your wrist. He or she will then look at your wrist, find any swollen or tender areas, and see how well you are able to move your wrist and thumb. Your doctor will also try to find out how well blood is flowing to your hand and if you have any nerve damage in your wrist.
Most likely, your doctor will order X-rays of your wrist. Sometimes an X-ray clearly shows a scaphoid fracture. Other times, an X-ray may not show signs of a fracture. If your doctor is not sure if your wrist is broken, he or she may refer you to anorthopedist, a doctor who specializes in bone problems. Because fractures cannot always be seen right away, you may need a follow-up X-ray in 1 to 2 weeks. In the meantime, to prevent possible long-term problems, you will be treated as if you do have a fracture.
Treatment of scaphoid fractures depends on the location of the break in the bone.
Fracture Near the Thumb
Scaphoid fractures that are closer to the thumb usually heal in a matter of weeks with proper protection. This part of the scaphoid bone has a good supply of blood, which is necessary for healing.
Your doctor will place your arm and hand in a cast. The cast will usually be below the elbow. It may or may not include the thumb.
The time it takes for the fracture to heal varies from person to person. Your doctor will monitor the healing by taking periodic x-rays or other imaging studies, such as a computed tomography (CT) scan. These imaging studies are used to confirm that the bone has healed.
Fracture Near the Forearm
If the scaphoid is broken in the middle of the bone (waist) or closer to the forearm (proximal pole), healing is more difficult. These areas of the scaphoid do not have a very good blood supply.
If your doctor treats this type of fracture with a cast, the cast will probably include the thumb. It may extend above the elbow, as well.
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.
(Left) This x-ray shows a scaphoid fracture fixed in place with a screw. (Right) This x-ray was taken 4 months after surgery. The fracture of the scaphoid is healed.
Whether your scaphoid fracture requires surgery or not, you will need to wear a cast or splint while the fracture heals. This may be for as long as 6 months. During this period of healing, unless approved by your doctor:
• Avoid heavy lifting, carrying, pushing, pulling, or throwing with the injured arm
• Do not participate in contact sports
• Do not climb ladders or trees
• Avoid activities with a risk of falling onto hand (for example, inline skating, jumping on a trampoline)
Some people have wrist stiffness after scaphoid fractures. This is more common when a cast was needed for a long time or when the fracture required more extensive surgery.
It is very important to maintain full finger motion throughout the recovery period. Your doctor will provide an exercise program, and may recommend hand therapy to help you regain motion and strength in your wrist.
Even with therapy, some people do not recover the same motion and strength in their wrists that they had before their injuries.