Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Fracture of the Scaphoid

Fracture of the scaphoid

A fracture of the scaphoid bone in the wrist can result from a fall with the wrist bent backwards on an extended arm. The injury is particularly common in contact sports such as soccer, American football, rugby, ice hockey, and team handball, but can also occur in skiers and others.

The blood flow to the scaphoid is easily compromised, especially in fractures of its middle portion, and this slows the healing process. Athletes often find it difficult to accept the prolonged treatment that is needed for this injury to heal.

Symptoms and diagnosis

– Moderate pain is felt with tenderness and swelling in the scaphoid region (the hollow formed at the base of the extended thumb: the anatomic snuffbox).
– Power is moderately impaired during hand movements.
– The injury is often disregarded and is looked upon as a sprain because of the apparent triviality of immediate symptoms.
– An X-ray and bone scan or MRI will confirm the diagnosis.

Treatment

The athlete should consult a doctor for an X-ray in the case of any hand injury that could involve a fracture of the scaphoid.

The doctor may:
– apply a plaster cast or a brace when there is a suspected fracture, even if the early X-ray does not show one. A further X-ray should be taken 2–3 weeks later as it can take a long time for the bony changes to be revealed; a bone scan can, in some cases, be carried out earlier;
– when a fracture is present, apply a plaster cast. Immobilization of the wrist should continue for at least 3 months, with serial X-ray examinations to monitor healing;
– operate, in cases with any displacement of the fracture.

Healing and complications

– It is not unusual for the injured athlete to fail to consult a doctor and for the early symptoms to disappear. In these circumstances, healing may not occur and a false joint can be formed. This may ultimately cause degenerative changes in the wrist with discomfort, pain during movement, stiffness, and impaired function.
– Premature cessation of treatment, or sometimes even adequate treatment, can be followed by formation of a false joint (pseudarthrosis). A pseudarthrosis of the scaphoid should have surgical fixation.
– Athletes can, in spite of a fracture of the scaphoid, continue with acceptable conditioning activity.

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