Scaphoid Fractures

The scaphoid is one of the small bones in the wrist which make up the carpal bones and is found at the base of the thumb. It connects the proximal row, which is closer to the forearm, and the distal row of the carpus, which is near the hand. The scaphoid may be fractured when falling onto an outstretched hand.

Pain and swelling are experienced on the thumb side of the wrist, especially with movement. Because the scaphoid is one of many bones in the wrist, it may not be that painful and may be confused with a wrist sprain. Immediate medical attention is required because delaying treatment can cause further problems.

Diagnosis requires x-rays which, unfortunately, may not always show the fracture straight away. A fracture that is not detected or seen on an x-ray is called an occult fracture. X-rays may need to be repeated after 2 weeks, or alternatively, a CT or MRI scan may be done. A CT or MRI scan is used to get a clearer view of the scaphoid, which then assists the orthopaedic surgeon in making an accurate diagnosis. The CT or MRI scan can pick up fractures that are missed on x-ray.

Once diagnosed, treatment depends on the type of fracture and whether it is stable, unstable or displaced. The main goal of treatment of scaphoid fractures is to get the fracture to heal, which will relieve pain, maximise function and prevent the occurrence of arthritis. If the scaphoid is broken, the blood vessels that supply the bone with nutrients may also be damaged. This makes the scaphoid prone to non-union where the break does not heal. In some cases, scaphoid fractures may be treated conservatively with the use of a brace or cast. Others may need surgical fixation with a screw or pins to stabilise the bone. Surgery is usually indicated if the fracture is displaced (when the bone ends have shifted from their proper position) or unstable. If a non-union occurs, then surgery will also be required.