Scaphoid Fractures

Fractures of the scaphoid, a bone in your wrist, are not to be taken lightly. This is the only bone of the body that I know of that has an entire book written about how hard it is to diagnose and treat scaphoid fractures, and what to do when a fracture does not heal! Most of the time, a broken bone is obvious. The area around the break may be painful, swollen or deformed. But sometimes a bone can break without your realizing it. That ’ s can happen to the scaphoid (pronounced “skaf’-oyd”). Some doctors call this bone the “navicular”, but this is an older, out of favor term. Many people with a fractured scaphoid think they have a sprained wrist instead of a broken bone because there is no obvious deformity and very little swelling. If you’ve fallen and think you’ve sprained your wrist, call Dr. Bernstein for an appointment as soon as possible. Rest your wrist until you get seen.
The scaphoid bone is located on the thumb side of your wrist, close to the lower arm bones. It is shaped like a cashew, which makes it hard to visualize on the x – ray.
The reason scaphoid fractures have a hard time healing is due to the anatomy of the blood supply to the bone. The blood supply is what keeps the bone alive and allows it to heal. Most of the bone is covered with cartilage, the smooth shiny material that forms the joints and allows the bones to move. Blood vessels cannot enter through the cartilage; they enter only through the bone. Since the scaphoid is mostly covered in cartilage, there is a limited area for the arteries to enter the bone. In the scaphoid, the blood supply to the bone enters from the distal end, that is, the end toward your fingers. This can be a problem for healing, since most fractures occur in the middle or lower portion of the bone. The blood supply to the proximal fragment, that is, the piece that is toward your elbow, may not have any blood supply. Without a blood supply, the bone cannot heal and that fragment may die.
Who Gets Scaphoid Fractures?
Scaphoid fractures account for about 60 percent of all wrist (carpal) fractures. They usually occur in men between ages 20 and 40 years, and are less common in children or in older adults. The break usually occurs during a fall on the outstretched hand. It’s a common injury in sports and motor vehicle accidents. The angle at which the hand hits the ground determines the injury. The following is a very rough “rule of thumb”: If the wrist is bent at a 90 – degree angle or greater, the scaphoid bone will break; if the angle is less than 90 degrees, the lower arm bone (radius) will break.
Signs and Symptoms
- Pain and tenderness on the thumb side of the wrist.
- Motion (gripping) may be painful.
- May be some swelling on back and thumb side of wrist.
- Pain may subside, and then return as a deep, dull aching.
- Marked tenderness to pressure on the “anatomical snuffbox,” (a triangular-shaped area on the side of the hand between two tendons that lead to the thumb.)