What is a scaphoid fracture?

It's situated below the radius bone (one of the forearm's two large bones) on the thumb side of the wrist. The scaphoid bone is integral to the movement and stability of the wrist.

Due to the scaphoid bone's location, it is one of the most vulnerable carpal bones. Research shows that it accounts for 70 per cent of carpal fractures.

What causes a scaphoid fracture?

A scaphoid fracture is typically caused by a fall onto an outstretched hand, known as 'FOOSH' for short. When you feel like you are falling, it is instinctive for you to cock your wrist and extend your arm, using your hand to break the fall. This mechanism protects other parts of the body from injury, but it can mean that your arm and wrist take the full impact. This is when a scaphoid fracture can happen. This type of FOOSH injury can happen in a broad variety of sports; from skiing, snowboarding and ice skating, to football and rugby.

Symptoms of scaphoid fracture

The most common symptom of a scaphoid fracture is tenderness and pain over the anatomic snuffbox, which is the triangular deepening found in the wrist at the base of the thumb. This pain can be quite mild but can get worse when making movements such as gripping and pinching.

In many cases, there are no obvious symptoms of a scaphoid fracture, with swelling or deformity not being visible to the naked eye. It is possible that the pain can improve following the occurrence of a fracture, and this is why many people can delay getting treatment, thinking that they just have a sprained wrist. The problem of delaying treatment is that the fracture could fail to heal. This is known as a scaphoid nonunion.

Treatment options for scaphoid fracture

X-ray is the most common tool which doctors will use for diagnosis. But some scaphoid fractures cannot be spotted with an x-ray immediately after an injury. Your doctor may suspect a scaphoid fracture, even though it cannot be seen, and in these cases, a thumb splint is likely to be used to immobilise your wrist until CT scans or MRI scans can be obtained, to help determine the best treatment for a scaphoid fracture.

The treatment which is chosen for a scaphoid fracture will depend on; how severely the fractured bone is misaligned; the location of the fracture; and how long it has been since the injury occurred.

Treatment options include; a plaster cast, immobilising the wrist for potentially up to 12 weeks until the fracture has healed or surgery, minimally displaced fractures can sometimes undergo a smaller operation that involves an incision at the back of the wrist and the placement of a screw to compress fragments together. More complex fractures can require open surgery in order to realign fragments before stabilisation with a screw, aiding the healing process. In the case of a scaphoid nonunion following a scaphoid fracture, open surgery involving a bone graft may be required.

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