Scaphoid Fracture

A complete or incomplete break in the scaphoid bone of the hand is known as a scaphoid fracture. There is a poor supply of blood to the scaphoid bone, and this results in a poor rate of healing.

SYMPTOMS

  • Usually, severe pain at the time of injury.

  • Pain, tenderness, swelling, and occasionally bruising around the fracture site.

  • Numbness, coldness, and swelling in the hand, causing pressure on the blood vessels or nerves (uncommon).

CAUSES

Scaphoid fractures are caused by direct or indirect trauma to the hand. This may happen while falling on an outstretched arm.

RISK INCREASES WITH:

  • Participation in contact sports or jumping sports (football, soccer, basketball, boxing, and wrestling).

  • Sports in which falling onto outstretched hands is likely (snowboarding, skateboarding, or rollerblading).

  • History of bone or joint disease, including osteoporosis or previous hand immobilization.

PREVENTION

  • Maintain physical fitness:

  • Cardiovascular fitness.

  • Forearm and wrist strength, flexibility, and endurance.

  • Wear fitted and padded protective equipment for the hand.

  • For sports in which falling is likely, wear fitted wrist protectors.

  • Learn and use proper technique when hitting, punching, or landing from a fall.

  • If you have had a previous injury, use tape or padding to protect your hand before participating in contact or jumping sports.

PROGNOSIS

Bone healing usually requires 4 to 5 months. If the bone does not heal, then surgery is necessary.

This bone may heal in an average of 4 to 5 months with treatment and normal alignment. The bone may not heal, even if the position of the bones is normal. Surgery is often needed.

RELATED COMPLICATIONS

  • Fracture does not heal.

  • Heals in a bad position.

  • Impaired blood supply to the fracture and bones.

  • Chronic pain, stiffness, or swelling of the hand and wrist, especially with prolonged casting.

  • Excessive bleeding in the hand, causing pressure and injury to nerves and blood vessels (rare).

  • Unstable or arthritic wrist joint following repeated injury or delayed treatment.

  • Shortening or injured bones.

  • Risks of surgery, including infection, bleeding, injury to nerves (numbness, weakness), nonunion, malunion, arthritis, and stiffness.

TREATMENT

Treatment varies depending on the severity of the injury. If the bone is out of alignment (displaced) then it must first be realigned (reduced). If the bone is in correct alignment ice and medicine can be used to help reduce pain and inflammation. The hand and wrist are then immobilized for a period of 4 to 5 months. If non-surgical (conservative) treatment is unsuccessful, surgery may be necessary. Surgery usually involves placing pins and screws in the bone. Pins and screws hold it in place. After surgery the hand and wrist are immobilized. After immobilization (with or without surgery), stretching and strengthening exercises is usually necessary to regain strength and a full range of motion. These exercises may be performed at home or with a therapist. Depending on the sport, a wrist brace may be recommended for wear when returning to sport.

MEDICATION

  • If pain medicine is necessary, then nonsteroidal anti-inflammatory medicines, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers are usually only prescribed after surgery. Use only as directed and only as much as you need.

HEAT AND COLD

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Pain, tenderness, or swelling worsens despite treatment.

  • You experience pain, tingling, numbness, or coldness in the hand.

  • Blue, gray, or dusky color appears in the fingernails.

  • Any of the following occur after surgery: fever, increased pain, swelling, redness, drainage, or bleeding in the surgical area.

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).