The Scaphoid is one of the eight carpal bones in the wrist. The carpal bones make up two rows, the Scaphoid is the only which bridges the rows, which puts it at risk of failure (break) due to sudden trauma.
Scaphoid fractures are usually caused by a fall on the outstretched hand (FOOSH). And most often in young adult men in their late teens and 20's(https://www.ncbi.nlm.nih.gov/pubmed/27143737). And most come in following FOOSH during sports (football, snowboarding, trail bike riding).
It is not uncommon for a Scaphoid fracture to be missed on early x-ray. Where there is a degree of suspicion of a Scaphoid fracture- repeat x-ray within a few weeks is strongly recommended. This is because the bone has a precarious blood supply, and even with slight change in alignment- this can be disrupted. If not diagnosed and managed appropriate early, lack of blood to part of the bone can result in bone death (necrosis). Which may result in ongoing wrist pain and degenerative changes, which may require surgery.
Ongoing pain on the thumb side of the wrist can be noticed immediately, and in some instances increase with time. It is not uncommon for people to think they have sprained their wrist, because swelling and bruising may be minor, and they may still have good movement.
Will be determined by whether the fracture has moved bone. If the bone is aligned very well (non-displaced), a firm custom made plastic or plaster cast can be used to support the injured wrist in appropriate alignment until the fracture has healed (6 weeks).
However if there is displacement at the fracture site surgical opinion is essential. Surgical fixation of the fracture will involve the use of a screw or pins. If necrosis of bone has occurred, a bone graft may be used to recreate the Scaphoid bone. A plastic or plaster cast will be used to hold the wrist still for 4-6 weeks. And scar management is required.
Following removal of the cast a graded strengthening program is required to safely return to sport and working activities.
Author Jo Marsh
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