The scaphoid is one of the smaller bones that form a part of the wrist. It is located just under the thumb.
A scaphoid fracture occurs most commonly when you fall on your outstretched hand. Pain and swelling around the wrist are typical symptoms of a scaphoid fracture. However, because of the complex anatomy of the wrist, a break in the scaphoid bone can sometimes be difficult to identify on X-Rays. Sometimes, it does not even show up on an X-Ray. If a scaphoid fracture goes undetected or if treatment is delayed, it can result in permanent and irreversible damage to the wrist.
Anatomy Of The Wrist
Unlike most other joints that typically consist of two large bones connected at a joint, the wrist joint has an extremely complex structure. It is made up of a collection of eight separate small bones called carpal bones. Each of these small bones forms a joint with the bone next to it. All the small bones are connected to each other and to the ulna, radius and metacarpal bones by ligaments.
In addition to providing the strength for heavy gripping, the elaborate structure of the wrist joint also gives it a high degree of mobility, which gives our hands a full range motion.
Common Causes Of Scaphoid Fractures
The scaphoid bone is a small carpal bone located just under the thumb. When falling forwards to the ground, most of us instinctively put out our hands to break the fall. While this may protect the face, falling on your outstretched hand puts a lot of force on the scaphoid bone. This sudden, excessive stress can cause the scaphoid bone to either crack at some point midway along its length or it can separate completely into two individual pieces.
A direct blow to the palm of your hand can also cause the scaphoid bone to break. In very rare cases, such as in the case of gymnasts and shot putters, scaphoid injuries may result from repeated stress on the scaphoid bone.
When you have a fractured scaphoid bone, you will most likely remember the specific fall or injury that may have caused the fracture as it would not have been an insignificant incident.
Symptoms Of A Scaphoid Fracture
Pain around the wrist is the most common symptom of a scaphoid injury. The pain may or may not be accompanied by bruising and swelling around the wrist on the affected side. The exact symptoms and the severity of the symptoms will depend on the extent of the fracture.
Most people may suspect that they have a fracture if the pain and swelling are severe. However, they are more likely to assume that they have suffered a simple sprain if the pain and swelling are mild and they don’t seek medical attention till much later. It is quite common for the fracture to be diagnosed only much later when the incessant pain or restricted wrist movement forces them to make an appointment with their doctor.
A doctor will first ask you to get an X-Ray done to confirm that you have a scaphoid injury. If it is too soon after the accident and the X-Ray does not show any signs of fracture, your doctor may order an MRI scan (magnetic resonance imaging) or other imaging tests in order to get a definitive diagnosis.
Scaphoid Injury Treatment
There are two types of scaphoid fractures – displaced and non-displaced.
In a non-displaced fracture, there is no movement of the bone fragments. All the broken bone fragments would still be in the same position.
In a displaced fracture, the broken bone fragments would have moved out of position.
If the X-Ray confirms a non-displaced scaphoid fracture, it is usually treated by putting the arm in a cast that extends from a little beyond the wrist up to the elbow. The cast is typically made of fibreglass or some other synthetic material and is worn for about six to twelve weeks until the scaphoid bone heals. Sometimes, it may need to be worn a little longer than twelve weeks.
If the X-Ray confirms a displaced scaphoid fracture, surgery may be required to heal the injury. This is done by making a small cut in the skin and inserting a small screw or a special pin into the scaphoid bone to hold the bone fragments together in the correct position. Further X-Rays may need to be done to confirm that the fracture has healed.
Depending on the type of fracture you suffered and treatment you underwent, you may need to also go for physiotherapy or occupational therapy sessions for six to eight weeks after the surgical or non-surgical treatment. The first few sessions will focus on reducing the pain and swelling. Your physiotherapist or occupational therapist may also recommend a few exercises that have been proven to help stabilise and strengthen the tendons and muscles around the wrist joint.
If your fine motor control or hand dexterity are compromised because of the scaphoid injury, the physiotherapist may recommend a few special exercises to improve function in these areas. You will also be given tips on different ways to perform everyday tasks while avoiding extra strain on the wrist joint.
Complications With Scaphoid Injuries
A scaphoid fracture usually heals well if it is diagnosed correctly and treated early. Unfortunately, this is not an easy injury to diagnose. The complex anatomy of the wrist makes accurate diagnosis challenging and in many cases, the fracture remains undetected and can lead to further complications. Some people may also suffer from premature osteoarthritis as a result of the scaphoid injury.
An undetected, un-treated scaphoid injury could eventually result in the movement of the wrist getting severely restricted. If a doctor fails to diagnose the scaphoid fracture and as a result the injury does not get the necessary treatment, it is tantamount to a medical negligence. According to the personal injury law in the UK, you may be entitled to file a claim for compensation for a scaphoid misdiagnosis due to medical negligence.