What is a scaphoid fracture?
A scaphoid fracture is the term used for a break in the scaphoid bone in the wrist. The scaphoid bone is one of eight carpal bones that conjoin and create your wrist. These small carpal bones form two rows of four, the cube-like bones articulate on one side with the radius and ulna bones of the forearm and on the other side with the metacarpal bones that lead to the thumb and fingers. The scaphoid bone sits on the outside of the wrist under the thumb.
Why and when does a scaphoid fracture happen?
The scaphoid bone is the most common carpal bone to fracture due to its larger size and location. Scaphoid fractures are normally the result of traumatic impact to wrist or repetitive micro-trauma. Sports or activities that involve repetitive pressure through the wrist like gymnastics and throwing sports can lead to micro-trauma and result in a stress fracture of the scaphoid (a partial break in the bone) which then can progress into a full fracture of the scaphoid. A high impact trauma to the wrist is normally from falling onto an outstretched hand. It is instinctive to put your hands out to save yourself when you fall but this means that your wrist impacts the hard floor with your body weight behind it which in many cases is too much strain for the carpal bones to bear, in particular the scaphoid bone.
What does a scaphoid fracture feel like?
A scaphoid fracture from trauma causes a very intense immediate sharp pain around the fracture site at the side of the wrist under the thumb. The sharp pain often radiates up into the forearm and into the rest of the hand. The fracture is often accompanied by swelling and bruising around wrist. The pain levels will be aggravated by most hand or wrist movements this makes weight bearing and gripping with the effected hand very painful. The intense pain after a break will last for several hours. Once the bone starts to heal there will be a dull continuous ache and stiffness from the swelling and healing process that can last from a couple of weeks to a month. During the healing process the bone is trying to knit together and re-unite, this stage can be quite painful and it is very important to rest through this stage to ensure that the bone reconnects properly. The soft tissue surrounding the fracture also starts to form scar tissue to bind everything together allowing the structure to try and restore its original state and function.
How will a scaphoid fracture be diagnosed?
Patients may be taken to A&E and a full examination will be done to rule out any additional injuries or complications like nerve damage or infection. In the case of a fracture your doctor would normally order an X-ray to confirm the diagnosis. However the scaphoid bone is very difficult to visualise on an X-ray and in some cases the fracture isn’t actually visible until 10 days after the trauma making it hard to confirm the diagnosis. Your doctor will still most likely refer for an X-ray, if the results are inconclusive a second X--ray will be done in 10 days’ time once the bone has started to heal as this helps it show on the X-ray. Occasionally in these cases an MRI or a CT scan will be ordered as this will give a more detailed view of the fractured site although this is rare due to the expense. Doctors may also use an MRI scan to assess whether the pain felt after trauma is coming from injury to the wrist and hand muscles, ligaments or joint capsules and not indeed from a fracture. The occurrence of a scaphoid fracture from mild trauma may prompt doctors to investigate for any underlying bone weakening conditions like osteoporosis.
What treatment options are available for a scaphoid fracture?
The treatment options and healing times for scaphoid fractures vary depending on the position and severity of the fracture and also on the complications from any additional injuries like nerve or arterial damage. In most cases doctors will recommend conservative treatment using a hand splint or cast to immobilise, reinforce and stabilise the fracture for over 8-12 weeks until it is well healed. Occasionally if the fracture is diagnosed late and the fractured bone has fragmented away then surgical removal or fixation of the bone fragment is the best option making early diagnosis important. Surgery is followed up by a short period of time immobilised in a cast or splint. Patients will initially have to rest and avoid using the effected hand whilst recovering. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. A scaphoid fracture can take anything from 8 - 12 weeks to heal if not longer for more severe breaks. Patients will be referred through to a physiotherapist who will provide exercises to strengthen the hand to aid the healing process. Fluctuating pain levels will be experienced throughout the healing process however most of the discomfort towards the end of the healing process comes from stiffness levels caused by long term immobility. The rehabilitation exercises as well as massage and some manipulative therapies can aid in recovering your wrist and hand strength and flexibility. There are also great products to use at home to rebuild grip and hand strength such as therapeutic putty and therapy balls.