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Scaphoid Fractures

At the Hand Center of Louisiana, we commonly treat patients who have experienced scaphoid fractures at our New Orleans, LA facility. One of the most common hand and upper extremity conditions, it can be painful and interrupt your ability to perform daily activities. Understanding this condition, including its causes, symptoms, and subsequent treatment options, can help you make an informed decision of whether to seek medical evaluation.

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What are Scaphoid Fractures?

The scaphoid bone is one of the eight small bones that make up the “carpal bones” of the wrist. There are two rows of bones, one closer to the forearm (proximal row) and the other closer to the hand (distal row). The scaphoid bone is unique in that it links the two rows together. This puts it at extra risk for injury, which accounts for it being the most commonly fractured carpal bone.

How do Scaphoid Fractures Occur?

Fractures of the scaphoid occur most commonly from a fall on the outstretched hand. Usually it hurts at first, but the pain may improve quickly, over the course of days or weeks. Bruising is rare, and there is usually no visible deformity and only minimal swelling. Since there is no deformity, many people with this injury mistakenly assume that they have just sprained their wrist, leading to a delay in seeking evaluation. It is common for people who have fractured this bone to not become aware of it until months or years after the event.

Scaphoid fractures may also occur during motor vehicle collisions or sports activities such as skating or skiing. There are no specific medical conditions or risk factors that make you more susceptible to scaphoid fractures. However, several studies show that using wrist-guards during high-impact activities can help decrease the likelihood of fracturing the scaphoid.

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Diagnosis of Scaphoid Fractures

Scaphoid fractures are most commonly diagnosed by X-rays of the wrist. However, when the fracture is not displaced, X-rays taken early (first week) may appear negative. A non-displaced scaphoid fracture could thus be incorrectly diagnosed as a “sprain.” Therefore a patient who has significant tenderness directly over the scaphoid bone (which is located in the hollow at the thumb side of the wrist, or “snuffbox”) should be suspected of having a scaphoid fracture and be splinted (applying the use of wrist splints). An X-ray a couple of weeks later may then more clearly reveal the fracture. In questionable cases, MRI scan, CT scan, or bone scan may be used to help diagnose an acute scaphoid fracture.  CT scan and/or MRI are also used to assess fracture displacement and configuration. Until a definitive diagnosis is made, the patient should remain splinted to prevent movement of a possible fracture.

Non-Surgical Treatment of Scaphoid Fractures

If the fracture is non-displaced, it can be treated by immobilization in a cast that usually covers the forearm, hand, and thumb, and sometimes includes the elbow for the first phase of immobilization. Fracture healing time in a cast can range from 6-10 weeks and even longer. This is because the blood supply to the bone is variable and can be disrupted by the fracture, impairing bony healing.

Scaphoid Fracture Surgery

Part of the bone might even die after fracture due to loss of its blood supply, particularly in the proximal third of the bone, the part closest to the forearm. If the fracture is in this zone, or if it is at all displaced, surgery is more likely to be recommended. The goal of surgery is to realign and stabilize the fracture, which optimizing the chances the bone will heal.

Your doctor may recommend one or more of the following procedures:

Internal Fixation

In this procedure, your orthopaedic surgeon makes an incision to implant screws, pins, and/or wires to hold the scaphoid bone in place. The size of the incision and its location depend on the part of the scaphoid that is broken. In some cases, your doctor will make a larger incision in order to ensure the fragments of scaphoid align properly.

Bone Graft

Your physician may recommend the use of a bone graft. This may occur with or without internal fixation. This procedure takes bone from another part of your body (your forearm bone or hip) and places it around the broken scaphoid to promote fracture healing.

Reduction

In this procedure, your doctor will manipulate the bone into its proper position using a small incision and special instruments, which may include an arthroscope, which is a small camera. To limit the pain of this procedure, your physician will administer an anesthetic or anesthesia.

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Scaphoid Fracture Healing and Recovery

Scaphoid fractures often require you to wear a split or cast until your fracture heals, which may take up to 6 months. This timeframe remains the same whether you undergo surgical or non-surgical treatment.

Compared to other fractures, scaphoid fractures often heal slowly and call for limiting your activity level. Unless your doctor approves your engagement in certain activities, you should avoid participating in the following:

  • Lifting or moving objects that exceed more than one pound
  • Participating in sports
  • Climbing
  • Engaging in activities that present the risk of falling
  • Smoking (which may delay or prevent fracture healing)

During the recovery process, your doctor will recommend exercises to maintain the full range of motion in your fingers. Your doctor may also refer you to a physical therapist for hand and wrist therapy.

Complications of Scaphoid Fractures

Non-union

If a scaphoid fracture goes unrecognized, it often will not heal. Sometimes, even with treatment, it may not heal because of poor blood supply. Over time, the abnormal motion and collapse of the bone fragments may lead to mal-alignment within the wrist and subsequent arthritis. If caught before arthritis has developed, surgery may be performed to try to get the scaphoid to heal.

Avascular Necrosis

A portion of the scaphoid may die because of lack of blood supply, leading to collapse of the
bone and later arthritis. Fractures in the proximal one third of the bone, the part closest to the forearm, are more vulnerable to this complication. Again, if arthritis has not developed, surgery to try to stabilize the fracture and restore circulation to the bone may be attempted.

Post-traumatic Arthritis

If arthritis has already developed, salvage-type procedures may be considered, such as removal of degenerated bone or partial or complete fusion of the wrist joint.

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Our Orthopaedic Surgeons and Specialists

At the Hand Center of Louisiana, our orthopaedic surgeons specialize in the medical evaluation and treatment of scaphoid fractures. They are committed to providing patient-focused care using state-of-the-art technology in a comfortable atmosphere.

Our dedicated, talented physicians include:

Why Choose The Hand Center of Louisiana?

The Hand Center of Louisiana is a leading healthcare provider serving patients across the Gulf South for more than 40 years. As the largest hand and upper extremity practice in the Gulf South region, the Hand Center of Louisiana provides fully integrated care that includes thorough medical evaluation and treatment by our highly trained physicians; state-of-the-art diagnostic capabilities; wrist and hand therapy from our physical therapists; and a patient-focused approach that optimizes comfort, convenience and support.

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A scaphoid fracture is a painful condition that can significantly interrupt your daily activities. While commonly caused by falls, this injury may occur during accidents or sporting activities. Getting timely evaluation and treatment of scaphoid fractures is important to prevent complications or further trauma. Treatment may include non-surgical and/or surgical interventions to ensure the bone heals successfully and properly. If you believe you have a scaphoid fracture, contact us today to schedule your appointment with one of our highly trained physicians. They will evaluate your condition and develop the best course of treatment for your needs.

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