Scaphoid fractures
A scaphoid fracture refers to a break in the scaphoid bone, which is one of the small bones located in the wrist. The scaphoid bone is situated on the thumb side of the wrist, near the base of the thumb.
Scaphoid fractures often occur as a result of a fall onto an outstretched hand, particularly when the hand is extended and the force is transmitted through the wrist. This type of injury is commonly seen in activities such as sports, particularly those involving contact or high-velocity movements.
Symptoms of a scaphoid fracture may include pain, swelling, tenderness, and difficulty moving the wrist or thumb. The pain is typically localised to the anatomical snuffbox, which is a triangular depression on the thumb side of the wrist.
Scaphoid fractures can be challenging to diagnose because the initial X-rays may not always reveal the fracture. In some cases, the fracture line may not be visible immediately, and follow-up X-rays or additional imaging tests, such as a CT scan or MRI, may be required for a more accurate diagnosis.
Treatment
For non-displaced or minimally displaced fractures, where the bone fragments remain in their normal position, immobilisation with a cast or splint is often the initial treatment. The cast or splint helps to keep the wrist and thumb in a stable position, allowing the fracture to heal. The duration of immobilisation typically ranges from 6 to 12 weeks, depending on the specific fracture and individual circumstances.
Surgery may be needed for displaced fractures or fractures that are not expected to heal well with non-surgical treatment. Internal fixation involves the use of a specialised screw to hold the bone fragments together and promote healing. The specific surgical technique and fixation method depend on the characteristics of the fracture.
In some cases, if there is a significant gap between the fractured bone fragments or if the blood supply to the fractured portion is compromised, a bone graft may be required. The bone graft is typically taken from another part of the body (such as the forearm or pelvis). It is used to fill the gap and promote additional healing.
Recovery
The recovery time for a scaphoid fracture can vary depending on your specific injury. In general, it takes longer to recover from a scaphoid fracture than from other fractures. It may take three to sex months for a scphoid fracture to heal:
- Initial Healing Phase (6-8 weeks): In the first phase, the focus is on immobilisation and protection. You will usually need to wear a splint or a cast.
- Rehabilitation Phase (2-4 months): Once the initial healing has taken place, the next phase involves early mobilisation and gentle range-of-motion exercises. Your scaphoid will still need to be monitored with further X-Rays and in some cases a CT.
- Return to Normal Activities (4-6 months+): Once your fracture has healed, you can return to normal activities, such as manual work and sports.
Fracture non-union
Non-union of a scaphoid fracture refers to a situation where the fractured bone fails to heal. The rate of scaphoid non-union, or the failure of the scaphoid bone to heal after a fracture, can vary depending on several factors, including the location and type of fracture, the treatment approach, and individual patient characteristics. The reported rates of scaphoid non-union can range from approximately 5% to 30%.
Factors that can influence the rate of scaphoid non-union are:
- Fracture Location: Non-union is more likely to occur with fractures located in the middle or proximal third of the scaphoid bone compared to fractures near the distal end.
- Displacement: Fractures with significant displacement, where the bone fragments are not in their normal alignment, have a higher risk of non-union.
- Delayed Diagnosis and Treatment: Delay in diagnosing or treating a scaphoid fracture can increase the risk of non-union. Prompt identification and appropriate immobilisation or surgical intervention are important for successful healing.
Get Expert Help
If you have injured your scaphoid, it is important to get your injury evaluated and to perform appropriate diagnostic tests. Dr. Arthur Turow can assess your injury, provide you with an accurate diagnosis and suggest appropriate treatment options specific for your individual needs.
Please use above information as a guide only. More detailed information specific to your condition and your recovery will be given in your consultation with Dr. Arthur Turow, who will also provide additional resources to supplement your discussion. For more information, please contact the rooms of Dr. Arthur Turow on (08) 8236 4179.