Scaphoid Fractures: Causes, Symptoms, and Treatment Options

A wrist injury can significantly impact your daily activities, from gripping objects to performing routine tasks. One of the most commonly fractured bones in the wrist is the scaphoid, a small bone located near the base of the thumb. Scaphoid fractures are often caused by falls onto an outstretched hand, and while they may not always be immediately painful, they require proper diagnosis and treatment to prevent long-term complications. In this article, we’ll discuss what scaphoid fractures are, the common causes and symptoms, and the available treatment options to help you recover fully.

What is a Scaphoid Fracture?

The scaphoid is one of eight small bones in the wrist that form the carpal bones, and it plays a critical role in stabilising the wrist joint. A scaphoid fracture occurs when this bone is broken, typically due to trauma. These fractures are often difficult to detect on initial examination and may be mistaken for a simple wrist sprain.

Common Causes of Scaphoid Fractures:

1. Falls Onto an Outstretched Hand: The most common cause of a scaphoid fracture is falling onto an outstretched hand, which places significant pressure on the wrist.
2. Sports Injuries: Athletes participating in sports that involve high-speed falls, such as snowboarding, football, or cycling, are more susceptible to scaphoid fractures.
3. Car Accidents: A sudden impact or bracing against the dashboard during a collision can cause the scaphoid to fracture.

Symptoms of a Scaphoid Fracture

Scaphoid fractures can be tricky to diagnose because the symptoms may be mild at first. Many patients mistake the injury for a simple sprain, delaying proper treatment. It’s important to recognise the signs early to avoid complications.

Key Symptoms Include:

• Pain in the Wrist: Pain is typically felt on the thumb side of the wrist, particularly when moving the wrist or gripping objects.
• Tenderness in the Snuffbox: The anatomical snuffbox is a small depression on the back of the hand at the base of the thumb. Tenderness in this area is a key indicator of a scaphoid fracture.
• Swelling and Bruising: Swelling around the wrist may develop, though bruising is less common.
• Limited Wrist Movement: You may experience difficulty moving your wrist, particularly when bending it backward or forward.
• Pain with Thumb Movement: Pain may increase when you move or use your thumb, especially during tasks that require grip strength.

Diagnosis of Scaphoid Fractures

Since scaphoid fractures can be subtle, a thorough examination is essential for accurate diagnosis. Your doctor will assess the injury through a combination of physical exams and imaging tests.

Diagnostic Steps Include:

1. Physical Examination: Your doctor will assess the wrist for tenderness, particularly in the snuffbox region, and check for any swelling or limited motion.

2. X-rays: Standard X-rays may not always show a scaphoid fracture initially, especially if the bone is broken in its middle or "waist" section. Repeat X-rays may be needed after a few weeks if symptoms persist.

3. MRI or CT Scan: In cases where the fracture is not clearly visible on an X-ray, an MRI or CT scan may be ordered to provide more detailed images of the bone.

Treatment Options for Scaphoid Fractures

The treatment for a scaphoid fracture depends on the location and severity of the break. In some cases, the bone can heal with conservative treatments like casting, while more severe fractures may require surgery to ensure proper healing.

Conservative Treatments:

1. Casting: If the fracture is non-displaced (meaning the bone fragments are still aligned), a cast may be used to immobilise the wrist while the bone heals. Casts typically need to be worn for 6-12 weeks, depending on the severity of the fracture.

2. Thumb Spica Cast: A thumb spica cast is a specialised cast that includes the thumb and wrist, providing extra support for the scaphoid bone as it heals.

3. Regular Monitoring: During the healing process, your doctor will monitor the progress with regular X-rays or scans to ensure the bone is healing correctly.

Surgical Treatments:

Surgery may be recommended if the scaphoid fracture is displaced (meaning the bone fragments have shifted out of place) or if conservative treatments fail to promote healing.

1. Internal Fixation: During surgery, screws or pins are inserted to hold the bone fragments in place and encourage proper healing. This procedure is known as internal fixation.

2. Bone Grafting: In cases where the fracture is not healing properly, a bone graft may be used to stimulate new bone growth. Bone grafts can be taken from another part of your body or from a donor.

After surgery, a cast or splint is usually worn for several weeks, followed by physical therapy to restore strength and range of motion to the wrist.

Complications of Scaphoid Fractures

If a scaphoid fracture is not properly treated, it can lead to complications such as non-union (when the bone does not heal) or avascular necrosis (when the blood supply to the bone is disrupted, causing the bone to die). Early treatment is key to preventing these issues and ensuring a full recovery.

Preventing Scaphoid Fractures

While it’s impossible to prevent all wrist injuries, especially in active individuals, there are steps you can take to reduce your risk of scaphoid fractures.

1. Use Protective Gear: When participating in sports or activities with a high risk of falls, such as skateboarding or skiing, wearing wrist guards or other protective gear can help reduce the impact on your wrists.

2. Strengthen Your Wrists: Regularly performing exercises to strengthen the muscles around your wrists can improve stability and reduce the likelihood of fractures.

3. Improve Balance and Coordination: Exercises that improve your balance and coordination can help prevent falls, reducing your overall risk of injury.

Conclusion: Treating and Recovering from Scaphoid Fractures

Scaphoid fractures are common injuries, particularly among active individuals and athletes. While they may not always cause immediate, severe pain, proper diagnosis and treatment are essential to avoid long-term complications like non-union or avascular necrosis. Whether treated conservatively with casting or surgically with internal fixation, the goal is to ensure the bone heals properly and that you can regain full function of your wrist. At MSK Doctors, we offer expert diagnosis and treatment for scaphoid fractures, helping you recover safely and effectively. Contact us today for a personalised treatment plan.

FAQ Section:

1. What is a scaphoid fracture? A scaphoid fracture is a break in one of the small bones of the wrist, located near the base of the thumb. It typically occurs from a fall onto an outstretched hand.

2. How do I know if I have a scaphoid fracture? Symptoms include pain and tenderness on the thumb side of the wrist, especially in the anatomical snuffbox, swelling, and difficulty moving the wrist or thumb.

3. Can scaphoid fractures heal on their own? Some scaphoid fractures can heal with conservative treatment, such as casting. However, if the fracture is displaced or doesn’t heal properly, surgery may be required.

4. How long does it take to recover from a scaphoid fracture? Recovery time varies depending on the severity of the fracture, but most patients need to wear a cast for 6-12 weeks. In more severe cases, surgical recovery may take several months.

5. What happens if a scaphoid fracture is left untreated? Untreated scaphoid fractures can lead to complications such as non-union, where the bone does not heal, or avascular necrosis, where the bone loses its blood supply and begins to die.

6. How can I prevent scaphoid fractures? Wearing wrist guards during high-risk activities, strengthening the wrist muscles, and improving your balance and coordination can help reduce the risk of a scaphoid fracture.