Scaphoid fracture is basically a wrist injury. Scaphoid is a carpal bone located in the wrist. It acts as a link between the proximal and distal carpal rows or we can say between the hand and forearm. It is one of the most common bone fractures due to maximum usage & vulnerability of the wrist during frequent movements. Young people are more likely to face it compared to adults. The peak age lies between 20 to 30 years, that too more prominently in males. 

Why scaphoid fracture is common? 

It mainly results from a fall with wrist hyperextension bringing load upon the scaphoid bone situated in the wrist, ultimately leading to a bone fracture. Due to situations when the palm is flat and stretched out, the wrist is bent backwards and is prone to take the entire load. For example, as one falls to the ground, out of reflex he’ll put the hands out first for protection. Sometimes a direct blow to the palm causes a scaphoid fracture. 

Repeated stress rarely leads to this type of fracture, as in the case of gymnasts, shot put players and players involved in games related to random, pressurized wrist movements. 

Why is it important to identify in early stages? 

The patient generally complains of a wrist pain often on the radial side of the wrist along with swelling which gets more painful with the movement of the wrist. In some patients the symptoms of wrist injury may be milder. They often assume that they have just sprained their wrist, therefore don’t seek medical advice until the pain doesn’t settle and increases with time especially while movement. 

Early sessions of treatment focus on reducing the pain and inflammation through exercises and stabilize the muscles around the wrist joint. 

If not treated at right time, the complications can occur and lead to – 

  • Malunion- bone healed but in an incorrect position or angle resulting into pain and problem in gripping 
  • Avascular necrosis- the blood supply gets blocked through the wrist because of fracture and even Osteoarthritis. Most of the Scaphoid fractures get healed without any complications. 
  • Avascular wrist arthritis- The exact severity of the symptoms depends upon the extent of the bone fracture. It is important to identify a scaphoid fracture early, as depending upon the blood supply of the patient the situation can get complicated leading to arthritis 

Why seeking medical attention is desirable? 

Only the doctors are able to make sure that no other allied developments in such cases can be seen as side effects in the long run. Usually they first examine the wrist / hand and enquire about the history of wrist movements in past days as it depends upon the type of bent the wrist has gone through. They also check a specific point where it is likely to be tender if there is a scaphoid fracture. This point is known as the anatomical snuffbox, a depression in the skin in the back of the hand near the base of thumb. 

X-ray is the simplest way for its detection. However, the anatomy of the wrist is quite complex which makes the identification a bit difficult through the X-ray. Since the scaphoid bone can move behind the other carpal bones and escape X-rays, specific scaphoid view X-ray taken by placing the hand and wrist in a certain position can help reveal a scaphoid fracture. Though 20 percent of scaphoid fractures may not be seen on X-ray first, it could take 2 weeks to be identified by repeated X-rays. 

In complicated cases, the next step is MRI- Scan (Magnetic Resonance Imaging) to identify the accurate severity of the fracture. Patients with a positive MRI Scaphoid test report (though the X-ray may show negative) must be managed immediately and aggressively as mainly in such instances the cases are of occult or hidden bone fractures. Immediate consultation of an orthopedic surgeon is required. He will guide for further steps to be taken. 

Available effective treatments 

The treatment of scaphoid fracture depends upon its type. By analyzing the X-ray or MRI report it can be easily detected whether it is Non-displaced or Displaced fracture. 

In non-displaced fracture where there is no movement of the bone fragments from the original place, the arm is treated by placing it in a “cast” extending from the wrist up to the elbow. The cast is generally made of fibre glass or other synthetic materials. 

  • Normally it is worn for 6 weeks. 
  • If no union is observed after 6 weeks, then it is prolonged until 12 weeks with continuous X-ray reports after every 2 weeks. 
  • Still if no signs of union are seen then ORIF Surgery (Open Reduction Internal Fixation) will be needed until the bone is healed. 
  • For the patients who are athletically active, percutaneous fixation is solution. 

In displaced fracture where the bone fragments have moved out of position, the risk of non union is higher. So a surgery is recommended by doctors to reposition the bones and hold them solidly in proper alignment. A screw or a special pin is inserted into the scaphoid bone to keep the bones at right position. This is normally done through a slight cut in the skin. Here too ORIF surgery works to reduce risk of recurring wrist pain