Scaphoid Fracture Treatment
A scaphoid bone is a small bone in the wrist. The wrist if formed by the radius and the ulna, the two larger bones that make up the forearm, and eight small carpal bones, which sit at the base of the hand. The scaphoid bone is one of the carpal bones at the base of the thumb. The term “scaphoid” comes from a Greek word for boat, which is the shape that the bone resembles.
When the hand is put in a “thumbs up” position, the scaphoid bone can be found at the base of the thumb where a hollow is made (sometimes called the “anatomical snuffbox”).
A break in the scaphoid, or a scaphoid fracture, often occurs due to a fall onto an outstretched hand, when the palm experiences significant impact. The radius bone sometimes also breaks in this type of fall. In addition to happening in a fall, this fracture can occur as a result of a car accident or during sports activities.
Scaphoid fractures are categorized by the type of displacement of the bone:
In a non-displaced fracture, the bone is broken, but remains in the correct alignment.
In a displaced fracture, the bone fragments move out of their normal position, with potential gaps in between the pieces of bone. Fragments may also overlap in a displaced fracture.
Your doctor will look for symptoms including swelling, bruising and loss of motion. If a scaphoid fracture is suspected, x-rays will be ordered to confirm a break and determine the extent of the fracture. Sometimes a scaphoid fracture may take a few weeks to show up in x-rays. For this reason, if a fracture is not immediately evident on the initial x-ray, your doctor may give you a splint and have your return in a week or two for another x-ray. A magnetic resonance imaging (MRI) and/or computerized tomography scan may also be done if the scaphoid fracture is not showing up on x-rays.
Based on the location of the break, when the injury occurred and whether the bones are displaced will dictate what course of treatment your doctor will recommend.
If the fracture is near the thumb (distal pole), the bone is likely to heal with a splint or cast, which will be placed from your thumb to the forearm below your elbow. Though healing times vary, the injury will typically heal in several weeks; near the thumb, the scaphoid bone has a strong supply of blood, which aids in healing.
If the fracture has taken place closer to the forearm (proximal pole) or the center of the scaphoid bone (called the scaphoid “waist”), healing can take more time, as these sections of the scaphoid receive less blood supply. This type of fracture may necessitate a cast that extends from your thumb to above the elbow for added stability. Sometimes a bone stimulator – a small device that delivers low-intensity ultrasonic or pulsed electromagnetic waves – can be recommended to assist in healing.
If the scaphoid bone is fractured at the bone’s waist or proximal pole, or if the bone is broken into pieces that are displaced, surgery may be recommended to stabilize the break. Types of surgical treatment for a scaphoid fracture may include:
- Reduction: In a reduction, the doctor’s goal is to move the scaphoid bone back into its correct position. This will be administered under local anesthetic or general anesthesia depending on the extent of the surgery. A reduction can sometimes be done arthroscopically, with a small incision and special guided instruments. In other cases, an open incision is made so that the doctor can more directly manipulate the fractured bone.
- Internal fixation: If the bone is broken in several pieces, sometimes with gaps, it may be necessary for a doctor to perform surgery and utilize metal implants. Screws and/or wires can hold the scaphoid in place until the bone is fully healed. Internal fixation may also be done arthroscopically or with an open incision, depending on the injury.
- Bone graft. In some cases, a bone graft, which is a new bone placed around the broken bone, may be needed (with or without internal fixation). A bone graft can stimulate bone production and healing. The graft may be taken from the forearm bone or the hip.
Following surgery, a cast or splint may be needed for up to six months. Scaphoid fractures, particularly at the waist and proximal pole can take a significant amount of time to heal. To avoid stiffness as much as possible during this period, an exercise program may be recommended, and you may be referred to a trained hand therapist to help rebuild range of motion and strength.
If you suspect that you may have broken your scaphoid bone, or need follow up care for a fracture, Orthopedic Associates of Northern California are here to help you receive the best care possible to regain function of your hand and wrist.