Scaphoid Fracture

The scaphoid is a bone in the wrist found on the thumb side and is the most commonly broken.

A fracture of the scaphoid is usually caused by a fall on an outstretched hand, with the weight landing on the palm. Scaphoid fractures can occur in all ages and typically occur with high-energy trauma. Most commonly men 20-30 years old experience these fractures.

Typical symptoms include pain and swelling at the wrist below the thumb resulting in an inability to move the thumb or wrist. Pain also prevents full grip. Some times fractures are missed as they are thought to be strains and in this case repeat x-rays should be done to ensure that there is no fracture.

Initial evaluation includes a medical history, physical examination, and x-rays to evaluate the extent and displacement of the injury. An MRI may be considered if clinical suspicion is high but no fracture is seen on x-ray. To evaluate displacement further a CT scan may be ordered.

Treatment of scaphoid fractures depends on the acuity, location, and displacement of the break. Fractures that are closer to the thumb have a better blood supply and may be treated with a cast. Fractures in the middle of the bone (waist) or closer to the forearm (proximal pole) have a poor blood supply often surgical treatment is indicated. Surgical treatment is an outpatient procedure and involves placement of a screw to hold the fragments in place. After surgery, a cast or splint must be worn until healing is noted. Recovery takes several months and therapy is started to ensure full hand motion and strength.