What is a Scaphoid Fracture?
On the thumb side of your wrist there is a small bone. A scaphoid fracture is a break in that small bone. In your wrist there are eight carpal bones and of these eight bones, the scaphoid is the one that you would most likely break if you broke any of these bones. The bone is boat-shaped and in your wrist joint this is a very important part. Although in young males between the ages of twenty and thirty years of age this is a common fracture it can happen to people of all ages and this includes children.
Scaphoid Fracture Symptoms
The main symptoms of a scaphoid fracture are swelling and pain at the base of your thumb. It may not be obvious that you have a scaphoid bone fracture unless you have a wrist that is deformed. There are other times that physicians mistake this type of fracture for a sprain because they pain is not too severe. If within a day of an injury to your hand and wrist you still have pain in that wrist that just will not go away you should see your physician to rule out a scaphoid fracture.
Other symptoms you may have in addition to pain can include:
- You may also have tenderness just below your thumb when you press on your wrist.
- People who are thin may see a bulging of their joint capsule because of the blood that is filling the wrist joint from the scaphoid fracture.
- Rapid swelling at the back of your wrist.
- Pain if you compress your thumb inwards toward your wrist.
- You may have bruises around your wrist.
If you have a nonunion scaphoid fracture, which is where there is no healing, the symptoms are more subtle. Some of these symptoms may include:
- Having pain when you use your wrist such as trying to grip something.
- The pain may be minimal.
Sometimes people will have these nonunion scaphoid fractures for many years and just did not realize it was a fracture because they thought it was a sprain. Overtime you can get degenerative arthritis in the wrist joint due to a nonunion fracture.
Causes of Scaphoid Fracture
The main cause of a scaphoid fracture is when you start to fall and you put your hand out in front of you to keep you from actually falling all the way down and you actually fall on your outstretched hand with most of your weight landing on the palm of your hand. They can also occur if your wrist is hit very hard or your wrist gets twisted severely. Many times these types of fractures happen when a person is person is playing sports such as basketball, football, or soccer. It could also be caused by doing other activities like skateboarding, riding your bike or motorcycle, rollerblading, etc. You could also have a scaphoid fracture if you have a punching incident or some type of vehicular accident.
If you have a nonunion scaphoid fracture it can happen because two pieces of bone have not healed together or the lower half of your fractured bone loses the blood supply and dies. When the second cause is the reason for a nonunion scaphoid fracture the condition is called avascular necrosis. The scaphoid bone is at risk for this condition because there is only one small artery that enters the bone closest to your thumb. If you tear the artery when you have a fracture you are going to lose your blood supply. There are no specific diseases or risks that increase your chances of having this type of fracture.
Scaphoid Fracture Treatment
There are two ways in which you can treat scaphoid fractures.
- Fracture occurs near your thumb – most of these fractures will heal on their own within a few weeks after having this accident with the right protection. Most likely your physician will put your hand and arm in a cast or splint but it is usually below your elbow and the cast may or may not include your thumb being in a cast.
- Fracture that happens near your forearm – with this fracture the physician will put a cast on that may go above your elbow and may include casting your thumb.
You may have to have surgery to implant a metal device such as wires and screws if you have a scaphoid fracture near your forearms or in the middle of your bone. The metal implants will hold the fractured scaphoid in place until it is completely healed. How large the incision will be and whether the incision is on the back or the front of your wrist will depend on what part of the bone is broken. If the bone is broke in more than a couple of pieces the physician may do a bone graph. This is where they take a new bone and place it around the one that is broken to help stimulate the healing of the fractured bone. Once healed the bone will be a solid bone. They usually get this bone graft from the forearm in the same arm where the fracture occurred.
Right after you have fractured your scaphoid it may be too swollen to have a cast put on so the physician may just use a splint until the swelling subsides. You may also have to wear a splint if the physician is not sure if you actually have a scaphoid fracture they may just have you wear a splint. To help reduce swelling you should use ice packs.
With a fracture near your thumb the time it will take for it to heal will vary with each individual. With this type of fracture the physician will periodically take images such as x-rays to check the healing process. If the fracture is near your forearm or in the middle of the bone the healing process is more difficult.
When you have a cast on your scaphoid fracture and you did or did not have surgery the actual healing time does vary but you can wear the splint or cast for as long as six months.