Peter G. Fitzgibbons, MD
Hand & Upper Extremity Surgeon
The scaphoid bone, also called the navicular bone, is a small, boat-shaped bone in the wrist that forms the wrist joint with 7 other bones. It is present on the thumb side of the wrist which makes it a high risk for fractures. A scaphoid fracture is usually seen in young men aged 20 to 30 years. They can occur at two places: near the thumb (distal pole) or near the forearm (proximal pole).
Scaphoid fractures usually occur from a fall on an outstretched hand with your complete weight falling onto the palm of the hand. This fracture usually occurs during motor accidents or sports activities.
Signs and Symptoms
Symptoms of a scaphoid fracture include pain and swelling at the site of the injury (base of the thumb and forearm). There is usually no deformity at the site of the fracture and therefore may be mistaken for just a sprain. Bruising is also a very rare symptom of the fracture. There are chances that you may not be aware of the fracture for months or even years after the fall as the pain generally improves in a few days.
Scaphoid fractures are diagnosed by X-rays; however, a non-displaced fracture does not always show up on an X-ray when it is taken early in the first week. Therefore, your doctor will test for tenderness at the site of the scaphoid bone to detect a fracture. Your doctor will also advise you to use a splint and avoid lifting anything heavy for a few weeks and then order another X-ray to check for visibility of the fracture. Sometimes, an MRI scan, CT scan or bone scan may also be ordered to confirm a diagnosis of scaphoid fracture.
Treatment for a scaphoid fracture is based on the site of the fracture i.e. the fracture near the thumb or near the forearm.
Non-surgical Treatment: Your doctor may suggest non-surgical treatment when the scaphoid fracture is not displaced. Non-surgical treatment involves immobilization of the forearm, hand and/or thumb in a cast. It may also include the elbow in case of fractures near the forearm. The time needed for the fracture to heal ranges from 6 – 10 weeks. Fractures near the thumb take relatively less time to heal when compared to fractures near the forearm as the blood supply necessary for healing is better near the thumb. Periodic X-rays are taken to monitor the healing process.
Nondisplaced scaphoid fractures may require surgery at the discretion of one’s doctor to enable earlier mobility.
Surgical treatment may be suggested when the fracture is displaced or is present closer to the forearm. For surgical treatment an incision is made either in the front or back of the wrist. Your surgeon will use screws and wires to hold the scaphoid bone in place as it heals. If the bone is broken into more than 2 pieces, a bone graft (bone usually taken from the forearm or hip) may be used to help in the healing process.
Following surgery, your hand will be placed in a splint or cast until it completely heals. Until then, you will be advised by your doctor to avoid contact sports and not to lift, throw, push or pull heavy weights with the injured hand. During recovery, physical therapy will be ordered to instruct you on certain exercises to help you regain strength and range of motion in your wrist.