The scaphoid bone makes up an important part of the wrist joint. It is located on the thumb side of the hand. Because of its location, it is the most frequently broken bone in the wrist. Scaphoid fractures can be mistaken for a sprain due to lack of symptoms and often there is only a little swelling which can settle down in a few days. The level of pain experienced varies.
Most of the time, fractured scaphoids will not show any obvious deformity of the wrist and can be overlooked and thought to be a common wrist sprain. This can delay a diagnosis by weeks, months or in some cases years after the initial injury.
Scaphoid fractures are classified into two types:
- A non-displaced fracture where the fragments of the scaphoid bone are still aligned following a break.
- A displaced fracture means that the pieces of the scaphoid bone move away from their normal alignment and causes gapping or overlapping of the bone.
Fracture of the Scaphoid can lead to wrist osteoarthritis, particularly if the fracture is untreated and does not heal properly.
The scaphoid has three parts:
- Proximal pole – This part is the end closest to your forearm
- Waist: This is the curved middle of the bone
- Distal Pole: This is the part that is the end closest to the thumb.
80% of fractures happen at the waist, 20% happen at the proximal pole and 10% occur at the distal pole.
Depending on the location of the fracture, affects how it will heal. Fractures in the distal pole and waist usually heal quickly because they have a good blood supply.
A fracture in the proximal pole can be difficult to heal quickly as bloody supply is easily cut off from a fracture which causes the bone to die, and thus will not repair well.
Treatment for a scaphoid fracture varies depending on the type of break. A non-displaced fracture can be treated non-surgically by using a cast or a splint. The bones do not need manipulating back into the correct position and a cast is used to immobilise the wrist so the bone can heal.
If the bones are displaced by the fracture, surgery is more likely as the surgeon may need to reset the bones and will sometimes use screws to fix the bones in place whilst they heal.
In some cases, a bone graft is needed to heal the fracture. This is where a small part of bone is taken from another point, usually the wrist or hip and placed within the break of the scaphoid to help it heal.
Recovery time for a scaphoid fracture depends on the extent of the injury and can be slower than other fractures because blood supply to the bone is limited. The healing ability is also influenced by other factors such as smoking and time from the injury.
In most cases, healing times are approximately 5-6 weeks with a cast in place. However, if there are complications with the healing process, a cast could be used for longer.
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