The scaphoid is one of the carpal bones of the wrist joint.
Scaphoid fractures usually occur following a fall on the outstretched hand. A fracture can occur at differing locations and differing patterns in the bone including; the tubercle, the waist and the proximal pole.
Healing of the scaphoid following fracture can take longer than other fractures. This is because the blood supply to the bone is easily disrupted following fracture. And even if a fracture is not seen on x-ray, blood flow can be interrupted. Which may result in ongoing pain and discomfort particularly in forceful gripping tasks.
Management of scaphoid fractures requires close and repeated radiographical assessment. And immobilisation in a custom-made cast is required to keep the bones well supported and still such that they can heal.
Proximal pole scaphoid fractures
Proximal pole fractures account for 10-20% of scaphoid fractures. If left untreated they have a high rate of non-union, that is not healing. Without healing, the blood flow to the bone can be compromised, which results in death or necrosis of the bone. This will almost certainly lead to a painful wrist and over time a change in the way the wrist bones and ligaments work together- and ultimately osteoarthritic changes.
Proximal pole fractures are not always seen on x-ray. Therefore, if we have a reasonable degree of suspicion of proximal pole fracture we will always refer back to the treating GP for further radiographical examination.
Non-operative management of proximal pole of the scaphoid fractures is unlikely going to be successful- hence we always recommend early referral to a Plastic or Orthopaedic surgeon who is experienced in carpal bone surgery. Surgery usually involves the insertion of a screw to stabilise the fracture and often a k-wire- which will be removed within the first couple of months following surgery. Immobilisation in a custom-made thermoplastic splint is required for several weeks. Managing swelling, scar formation and splint position is the role of the hand therapist. We have tricks to help maintain strength in the hand whilst it is resting in the splint. And as the bone is healed help you regain strength and function once the bone is well healed.
The take home message here is: if you are diagnosed with a proximal pole of the scaphoid fracture- it is best to seek early surgical opinion.
Author Jo Marsh
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