What Is The Scaphoid?
The scaphoid is one of the eight small carpal bones that make up the wrist. The scaphoid is most important for motion and stability in the wrist joint. It has a long curved shape to it. When giving the “thumbs-up” it is easily identified at the base of the thumb between the tendons. This area is known as the “anatomic snuffbox”.
What Causes A Scaphoid Fracture?
A scaphoid fracture occurs most often after a fall onto an outstretched hand. The most common symptom of a scaphoid fracture is pain and tenderness to palpation in the wrist, towards the base of the thumb. Pain will be worse when trying to make a fist or grab something. There is also often swelling associated, though a deformity is usually not seen. If the pain persists for several days then an evaluation by a physician is necessary. Prompt evaluation of fracture is important because treatment of a scaphoid fracture early can help to avoid complications.
A scaphoid fracture is described by its location within the bone and the degree of displacement (how much the fracture has shifted). The location of the scaphoid fracture is described as either the distal pole, waist, or proximal pole. The scaphoid fracture can be described as non-displaced (the fracture has not moved) or displaced (the fracture has moved).
Treating Scaphoid Fractures
Depending on the patient’s age, location of the fracture, and displacement of the fracture, treatment can vary. The blood supply to the scaphoid is poor, which can lead to problems with healing and potential complications with treatment.
Scaphoid Fracture Diagnoisis
Your doctor will start by performing a thorough history. Details regarding the injury, symptoms, and location of pain are important to aid in the diagnosis. Your doctor will also perform a thorough physical examination of the wrist. If the patient is tender directly over the scaphoid then there may be high suspicion for a scaphoid fracture.
Scaphoid Fracture Imaging
Multiple X-ray views of the wrist will aid the doctor in diagnosing a scaphoid fracture. Sometimes a scaphoid fracture does not show up on the x-ray immediately. If the suspicion for a fracture is high your doctor may recommend a splint or cast for 2 weeks and then have you return for a follow-up x-ray. If there is a true scaphoid fracture then it should become apparent at that time. Additional imaging such as an MRI or CT scan may be done to further evaluate for the presence of a scaphoid fracture or the amount of displacement of the fracture.
Scaphoid Fracture Treatments
The treatment chosen for the scaphoid fracture will depend on several key factors: the location of the fracture, the pattern of the fracture, the degree of displacement, and how long ago the fracture occurred.
Nondisplaced scaphoid fractures will typically heal well with a cast. The doctor will often place the patient into a cast that includes the thumb and forearm. The cast will typically be worn for 6 weeks.
Surgical Treatments For Scaphoid Fractures
If your scaphoid fracture is displaced then surgery may be recommended. The goal of surgery is to realign the bones and hold them in place so that they can heal properly. This is typically done in the operating room under anesthesia with an incision and screws.
Healing A Scaphoid Fracture
Blood supply is very important to heal bones properly. The scaphoid bone has a poor blood supply, particularly towards the proximal pole. Scaphoid fractures that are not identified and treated early, or those in the proximal pole, may take longer to heal or even possibly not heal (nonunion). If your scaphoid fracture does not heal, surgery may be required to insert a bone graft and a screw.
In scaphoid fractures, if the blood supply to one of the bone fragments becomes disrupted this fragment can die (avascular necrosis). If this happens then the bone may collapse. In these situations, a more complicated surgery may need to be performed using a vascularized bone graft (a piece of bone with blood supply still intact) in an attempt to reconstitute the bone.
Regardless of the treatment option chosen (surgical vs. non-surgical), recovery from a scaphoid fracture can be a prolonged process. It may require some sort of splinting or casting for up to 3 months. It is very important to follow the restrictions provided by your doctor.
When To See The Pediatric Orthopedic Center
If you feel your child is experiencing symptoms or signs related to this condition, it may be time to visit us. The Pediatric Orthopedic Center is the premier NJ hub for pediatric orthopedics, with three offices throughout northern NJ. Having been the leader in pediatric orthopedics in this area for 30 years, we are the largest and most award-winning pediatric orthopedic practice in the tri-state area.
