Falls and accidents are the culprits behind many patient reports of wrist pain. One possible outcome when force occurs against a bone is a scaphoid fracture. Depending on the nature of the fracture, a hand doctor will cover the thumb, hand, lower arm, and sometimes the elbow with a cast or perform surgery.
Overview of Scaphoid Fractures
The scaphoid is one of eight small bones in the wrist. Found near the thumb, it most often breaks when someone falls onto an outstretched hand. The Ohio State University states that many patients with scaphoid fractures assume they have sprained a wrist and remain unaware of a break for months or even years. This is because the symptoms are often similar to those of sprains:
- Pain centered in the thumb side of a wrist that lessens after a few days or more
- Swelling in the wrist or the hand
- Decreased strength in the affected wrist and hand
While many scaphoid fractures are spotted after X-rays, some are what is known as “occult” fractures. They are breaks that physicians cannot see on an X-ray, according to the American Society for Surgery of the Hand. Sometimes it is necessary to use CT or MRI imaging.
The American Academy of Orthopaedic Surgeons notes that because the blood supply to parts of the scaphoid is poor, complications during fracture healing are unfortunately common.
Treatment Options from a Hand Specialist
Treatment for a scaphoid fracture depends on several factors:
- Where the break in the bone occurred
- Whether there are displaced bone fragments
- How much time has passed since the injury
In a non-displaced fracture, bone fragments still align correctly. With a displaced fracture, fragments have left the normal position. They might overlap one another, or there could be gaps between bone pieces or fragments.
Many non-displaced scaphoid fractures heal within weeks without surgery. They require the protection of a cast and activity restrictions. For areas without a really good blood supply, casts that extend above the elbow are helpful.
Bone stimulators, small devices that emit waves to foster healing, also assist in healing wrist fractures. During the healing period, the physician will periodically monitor progress with imaging studies.
With a displaced fracture or break in the middle of the scaphoid, hand surgery is likely to be necessary. A hand surgeon seeks to realign and stabilize the bone with one or more procedures:
- Reduction: Using an anesthetic, the surgeon returns the bone to the correct position. Sometimes physicians utilize a small camera called an arthroscope to help accomplish this.
- Internal fixation: This involves placing screws and/or wires to hold the bone in place while it heals.
- Bone graft: It is sometimes used with internal fixation. Placing a graft around the fracture can spur the production of new bone.