Carpal Navicular Fracture (Scaphoid Fractures)

Scaphoid bones and fractures

The scaphoid bone is a compact bone within the wrist joint.

Scaphoid fractures are often the result of a fall when the hand is left outstretched, and the wrist takes the majority of the impact.

Scaphoid fractures account for 11% of all hand fractures and are most commonly found in males aged between 20 – 30 years old.

Unfortunately, a fracture to the scaphoid can often be very problematic. Firstly, due to the intricacies of the bone itself and secondly because often a scaphoid fracture can go undetected or misdiagnosed for a prolonged period (this is primarily because a fracture of this type can often be misdiagnosed as a severe sprain).

If detected at the right time, however, scaphoid fractures can be successfully treated (with an 85% chance of healing successfully), and you can expect a recovery time of approximately 12 weeks.

However, if treatment is delayed, recovery time can be in excess of 6 months, and often any fractures within the wrist joints will have an increased chance of not uniting and requiring further surgery.

If left untreated, the chances of painful arthritis and continued pain when moving your wrist and thumb all become increased over time.

Scaphoid Fractures diadnosis, treatment and aftercare

The Scaphoid Bone

The scaphoid bone within the joint of your wrist is a boat-shaped bone that is almost wholly covered in cartilage. We can think of it like a ball bearing that helps other bones to move around it as you twist and flex your wrist.

It takes a great deal of force and impact to break your scaphoid bone. In fact, it would take nearly double the amount of force to fracture your scaphoid bone compared to the force required to fracture one of your larger forearm bones!

However, despite its strength, scaphoid fractures are common and mainly occur when we stretch our hands out to break a fall.

It is also a common sporting injury, found to affect mainly men (men are ten times more likely to suffer a scaphoid fracture than women) who play football or other contact sports or suffer a car or motorcycle accident.

 Signs of a Scaphoid Fracture

  • Pain at the base of the thumb
  • The anatomic snuffbox will be tender and swollen

Is a scaphoid fracture serious?

In a word, yes.

Often because this type of fracture can often be overlooked, as following a fall or an accident, the immediate symptoms don’t necessarily suggest a fracture.

For example, swelling can be minor and can subside within a few days. The injury itself may also feel like a bad sprain, depending on individual pain thresholds.

However, scaphoid fractures can be slow to heal, and unlike a sprain, the pain will not subside over time. 

It’s also important to be aware that if the scaphoid bone is not receiving as much blood because the fracture has interrupted the supply or indeed closed it off completely, then the scaphoid bone will become more fragile and lead to other problems within the wrist (such as non-union of the fracture, avascular necrosis (part of the bone dies off), and arthritis.

Diagnosing Scaphoid Fractures

Unlike broken fingers and hands, scaphoid fractures seldom show any signs of deformities of the wrist; hence, diagnosis can often be delayed or indeed mistake for a sprain.

At The Manchester Hand Surgeon, we will use x-rays to check for fractures to the wrist and to rule out the possibility of sprains.

However, not all x-rays will immediately detect and display a fracture. In these cases, more in-depth scans will be required, with repeat x-rays also being carried out one to two weeks after the initial scans (as this is typically the time frame where a fracture would appear if it were not there initially).

These scans can include an MRI and CT scans, to assess if a union between the bones is possible and to help identify the shape and position of the scaphoid bone and the intricacies and complexities of the hand and wrist.

Treatment of Scaphoid Fractures

 Casting or surgery are the two primary forms of treatment for scaphoid fractures.

Cast treatment

If, after careful consideration and full scans, we believe that the scaphoid bone has not entirely separated, we may recommend a casting to help immobilise the wrist, allowing the pieces of bone the opportunity to fuse back together.

A cast may be worn for 9-12 weeks, covering your wrist, thumb, and forearm.  Casting will help hold the bone in place as it successfully begins to bond and heal.

X-rays may be taken at periodic times to check on the healing process, and only when everything is 100% healed will the cast be removed.

However, due to the complexities of the wrist and scaphoid bone, a situation of non-union may occur, and surgery may be the only option.

There are two types of non-union:

  1. The two pieces of bone fail to fuse together so the bone can’t be repaired using a cast
  2. Where the blood supply to the bone is lost, and a condition called avascular necrosis develops.

Surgery

At The Manchester Hand Surgeon, we will discuss with you several different surgical treatments that may require a particular type of screw to help hold the bone in place.

Surgery typically takes between 30 to forty minutes and is performed under general anaesthetic. (Depending on the fracture, regional anaesthesia may also be used, where only the arm will be numbed).

Aftercare

As part of the aftercare at The Manchester Hand Surgeon, we will provide you with options suitable to you and your treatment.

Hand therapy and occupational therapy will be provided after surgery for 6-8 weeks. Providing you with exercises to strengthen all joint wrist muscles, as well as offer useful tips on how to avoid extra strain and pressure on the wrist.

These exercises will be used to strengthen the fine motor skills and control in your hand, as well as in the initial weeks after surgery, provide a focus for controlling the pain and reducing/limiting the swelling.

We also recommend light duties when first returning to work and to avoid any heavy lifting until we are satisfied that the bone is completely healed.

Depending on your motor insurance and the severity of your surgery, you may resume driving after 2-3 weeks.

If you think you may be suffering from a scaphoid fracture contact our hand specialists today to book your initial appointment.

Types of surgical treatment can include:

Screw Fixation – if the scaphoid fracture is immediately identified and surgery is carried out using screw fixation immediately, you will find recovery time to be much quicker. The screw fixation procedure involves placing a screw directly into the scaphoid bone, helping to hold it firmly in place until healed (this screw can often become a permanent implant too). Screw fixation ensures minimal scarring due to the small incision made through the thumb.

Scaphoid Debridement – this procedure involves making an incision into the wrist and where the bone fracture and non-union have been located. From here, the fracture line of the bone will be determined, and any scar tissue found between the broken scaphoid bone will be debrided (removed), creating a new bone surface so healing can begin.

Bone Graft – this type of surgery usually takes place where a previous scaphoid fracture has not healed or not healed correctly. This procedure will involve using bone tissue from your wrist or pelvis and placing it within the scaphoid fracture. This process helps to stimulate union on the bone surface and repair the damage incurred.

For all surgical options, the wrist will be kept in a cast or splint for between 8-12 weeks, until it is safe to resume strength and flexibility exercises.

Immediately after surgery, you will also find your wrist to be immobilised, this is normal, and we advise to restrict any movement for between 10-14 days, with movement starting to return slowly after this date.

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