Wagga Wagga: 265 Edward St (02) 6917 1321
Posted: April 23, 2021
Many common wrist injuries occur due to a fall on an outstretched hand.
This mechanism can cause numerous types of injuries including fractures, ligament sprains and cartilage injuries. One of the most important types of injuries to diagnose is a scaphoid fracture. Scaphoid injuries make up 15% of acute wrist injuries and 60% of all carpal fractures. These can be difficult to differentiate to a distal radius fracture but are important to diagnose, due to the possible severe implications of a missed diagnosis.
The scaphoid is the largest proximal row of carpal bones and forms the radial portion of the carpal tunnel. 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 – a condition where the bone does not receive enough blood to heal correctly, resulting in non-union and possible death of the fractured areas of bone.
There are also numerous ligaments which attach onto 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 and strength and decreased function.
There are certain clinical tests physiotherapists use to determine if a scaphoid fracture has occurred, such as palpation of the scaphoid 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.
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 involves insertion of a screw or pin to stabilise the fractured area.