The scaphoid bone, a small, boat-shaped bone at the base of the thumb in the wrist, is one of the most frequently injured carpal bones. Fractures can be challenging to diagnose and treat effectively. Prompt and accurate diagnosis is important due to the bone’s unique blood supply, which affects its healing process.
Identifying a Scaphoid Fracture
A scaphoid fracture often results from a fall onto an outstretched hand. Common symptoms include pain and swelling along the thumb side of the wrist, particularly in the anatomical snuffbox. The pain may be mild and sometimes mistaken for a wrist sprain, leading to delayed diagnosis.
Physical examination involves assessing tenderness over the anatomical snuffbox, a sensitive indicator of a possible scaphoid fracture. Initial diagnosis typically includes wrist X-rays, though fresh fractures may not always be visible. If a fracture is suspected despite negative X-rays, immobilization and repeat imaging after a few weeks are recommended. MRI or CT scans provide more detailed views and confirm diagnosis, especially for occult fractures.
Non-Surgical Approaches
Conservative treatment is suitable for stable, non-displaced scaphoid fractures, particularly those closer to the distal pole. This approach involves immobilizing the wrist to allow the bone to heal naturally. A thumb spica cast, covering the forearm, wrist, and thumb, keeps the bone still.
Immobilization duration varies by fracture location and severity, ranging from several weeks to months. Distal pole fractures, with better blood supply, may heal within 6-8 weeks. Fractures in the middle (waist) or proximal pole often require longer casting, sometimes 8-12 weeks or more.
Proximal pole fractures have a less robust blood supply, which can slow healing. Strict cast adherence is important for successful healing. Follow-up X-rays monitor progress.
Surgical Intervention
Surgery is the preferred treatment for scaphoid fractures that are displaced, unstable, or in areas with limited blood supply, such as the proximal pole. Fractures with displacement greater than 1 millimeter often indicate surgery, as this increases nonunion risk. Surgery is also considered when non-surgical treatment fails to achieve proper healing.
Surgical intervention aims to stabilize fractured bone fragments, promoting bone union. Open reduction and internal fixation (ORIF) is a common technique, involving an incision to realign fragments. Screws or wires hold the bone in place while it heals.
Headless compression screws are frequently employed, requiring central placement for optimal results. Bone grafting may be necessary for bone loss or poor healing to stimulate new growth. The specific method depends on fracture type, location, and displacement.
Post-Treatment Recovery
Recovery and rehabilitation are important for restoring wrist function after treatment. The typical healing timeline ranges from three to nine months, depending on fracture characteristics and individual healing capacity. After immobilization, the wrist and hand may experience stiffness and reduced muscle strength.
Physical therapy plays a significant role in rehabilitation, focusing on regaining range of motion and increasing strength. Exercises are gradually introduced, starting with gentle wrist and thumb movements, and progressing to strengthening with light weights or resistance bands. Measures to control swelling, such as elevation, are also part of early recovery. Gradual return to normal activities is advised, avoiding strenuous tasks until full healing is confirmed.
Potential complications include nonunion, where the bone fails to heal, and avascular necrosis (AVN), where disrupted blood supply leads to bone tissue death. Nonunion is more common in scaphoid fractures due to the bone’s limited blood supply. These complications can lead to chronic pain, reduced mobility, and arthritis. Persistent pain, decreased strength, or lack of healing on imaging may indicate these issues, requiring further medical evaluation.