Scaphoid fractures are common injuries that affect the wrist accounting for 70-80% of all carpal bone fractures. They usually occur after a fall onto an outstretched hand. The fracture heals poorly and requires quite significant immobilisation and rehabilitation.
Unfortunately, scaphoid fractures are common and often go misdiagnosed. We’ll discuss the anatomy of the wrist and the mechanism of injury, as well as the diagnosis and treatment options.
What is a scaphoid fracture?
The scaphoid bone is one of the eight carpal bones in the wrist and the foundation of the wrist. It’s the largest proximal row of carpal bones and forms the radial portion of the carpal tunnel.
The scaphoid is made up of three parts:
- Proximal pole – The end nearest to your thumb.
- Waist – This is the curved middle portion of the bone beneath the anatomical snuffbox.
- Distal pole – The end closest to where your forearm meets your hand.
A scaphoid fracture is a fracture of the scaphoid bone, commonly caused by a fall on an outstretched hand where the wrist is forced too far backwards or possibly forcefully bent forward.
Around 80% of scaphoid fractures occur at the waist, 20% at the proximal pole, and 10% at the distal pole.
These can be difficult to differentiate from a distal radius fracture but are essential to diagnose due to the possible severe implications of a missed diagnosis.
Common symptoms of a scaphoid fracture
- Swelling around the painful area.
- Chronic pain in the back of the hand, especially at the base of the thumb.
- Pinching your thumb to your index finger while your palm is facing downward causes pain.
- Reduced grip and pinch strength.
- A weak wrist.
- Restricted range of motion.
- Pain on the thumb side of the wrist.
Scaphoid fracture treatment
The scaphoid has a poor blood supply even without injury. Therefore, if not managed appropriately with a specific immobilising cast or brace, they can result in avascular necrosis. In this condition, the bone does not receive enough blood to heal correctly, resulting in non-union and possible death of the fractured areas of bone.
Numerous ligaments attach to the scaphoid bone to provide intrinsic support for the wrist. A scaphoid fracture can also cause damage to these ligaments, which can cause scapholunate instability or dissociation. Without appropriate treatment, this can result in long-term wrist instability, loss of range, strength and decreased function.
Scaphoid fracture management can be non-surgical or surgical. Non-surgical management is used for stable scaphoid fractures and involves cast immobilisation using a specific short-arm cast. Surgical management is typically only required for unstable and displaced fractures and needs a screw or pin insertion to stabilise the fractured area.
Do you need physio after scaphoid fracture?
Yes, physiotherapy treatments will focus on reducing pain and swelling initially. In order to help strengthen and stabilise the muscles around the wrist joint, your physiotherapist will gradually introduce exercises. Further exercises will be provided to improve fine motor control and hand dexterity. You will also receive advice from your physiotherapist on how to perform your activities to avoid further strain on your wrist joints.
A scaphoid fracture must be allowed to heal properly with the appropriate physiotherapy for the appropriate amount of time.
What is the fastest way to heal a scaphoid fracture?
Prompt diagnosis is the fastest way to heal a scaphoid fracture. Since the carpal scaphoid bone plays a critical role in wrist function, pathologic abnormalities can have serious consequences. Physiotherapists use specific clinical tests to determine if a scaphoid fracture has occurred, such as palpation and the scaphoid compression test. If a scaphoid fracture is a potential diagnosis, a referral will be made for a CT scan to confirm the injury, as these injuries are often missed on a standard wrist X-Ray.
How long does it take to recover from a scaphoid fracture?
Your recovery time from a scaphoid fracture will differ depending on the type of procedure you have, as well as how fast your body heals. The healing time of a scaphoid fracture is typically longer than that of other types of fractures.
Typically, the union of the scaphoid takes 12 weeks, but you might have to wear a cast or splint for up to 6 months.
Both conservative and surgical treatment for scaphoid fractures may result in complications. These include delayed union, osteonecrosis, pseudo-arthrosis, associated instability, arthrosis, and carpal joint collapse.
These complications may cause significant functional limitations in mobility and grip strength. Malalignment, failure to place the screw, re-operation, infections, and soft tissue injuries are all possible complications during surgery. It should also be noted that scaphoid non-union is still a complex issue to solve.
Early detection and optimal treatment will reduce these problems and prevent late complications.