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However, the injury may not always show up on an X-ray. A doctor will X-ray the wrist to confirm a diagnosis of a scaphoid bone fracture. Initially, treatment of a scaphoid bone fracture would be to apply ice or cold therapy, protect the wrist with bandaging or strapping and seek medical attention. The exact area of tenderness is called the anatomical snuff box and is located between two tendons on the thumb side of the wrist. An MRI scan is also suitable, however, a scaphoid fracture may not show up during the first 24 hours following injury. A CT scan is better for a recent acute injury if this type of fracture needs to be ruled out. It is the most common missed fracture resulting in legal claims. 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.A scaphoid fracture may show up on an X-ray, but not in all cases. Again, if arthritis has not developed, surgery to try to stabilize the fracture and restore circulation to the bone may be attempted. Fractures in the proximal one third of the bone, the part closest to the forearm, are more vulnerable to this complication.

If caught before arthritis has developed, surgery may be performed to try to get the scaphoid to heal.Īvascular necrosis: A portion of the scaphoid may die because of lack of blood supply, leading to collapse of the bone and later arthritis. Over time, the abnormal motion and collapse of the bone fragments may lead to mal-alignment within the wrist and subsequent arthritis. Sometimes, even with treatment, it may not heal because of poor blood supply.

Non-union: If a scaphoid fracture goes unrecognized, it often will not heal. Surgery to place a screw may also be recommended in non-displaced cases to avoid prolonged casting. With surgery, a screw or pins are inserted to stabilize the fracture, sometimes with a bone graft to help heal the bone (see Figure 3). If the fracture is in this zone, or if it is at all displaced, surgery is more likely to be recommended. 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. This is because the blood supply to the bone is variable and can be disrupted by the fracture, impairing bony healing. Healing time in a cast can range from 6- 10 weeks and even longer. 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. Until a definitive diagnosis is made, the patient should remain splinted to prevent movement of a possible fracture. CT scan and/or MRI are also used to assess fracture displacement and configuration. In questionable cases, MRI scan, CT scan, or bone scan may be used to help diagnose an acute scaphoid fracture. An X-ray a couple of weeks later may then more clearly reveal the fracture. 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 (see Figure 2).

However, when the fracture is not displaced, x-rays taken early (first week) may appear negative.

Scaphoid fractures are most commonly diagnosed by x-rays of the wrist. It is common for people who have fractured this bone to not become aware of it until months or years after the event. 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. Bruising is rare, and there is usually no visible deformity and only minimal swelling. Usually it hurts at first, but the pain may improve quickly, over the course of days or weeks. How do scaphoid fractures occur?įractures of the scaphoid occur most commonly from a fall on the outstretched hand. This puts it at extra risk for injury, which accounts for it being the most commonly fractured carpal bone. The scaphoid bone is unique in that it links the two rows together (see Figure 1). 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 one of the eight small bones that make up the “carpal bones” of the wrist.