The scaphoid is the most common of the carpal bones to be injured. A fracture of the scaphoid normally results from a fall onto the outstretched hand.
Symptoms of Scaphoid Fractures
There is pain, swelling and tenderness over the thumb side of the wrist. Radiographs of the wrist confirm a fracture. Occasionally initial radiographs taken soon after the injury may not show the fracture. If a fracture is suspected but not confirmed it should be treated as one, the wrist immobilised in a splint or cast and then re-examined and further radiographs taken 10-14 days after the injury. An MRI scan of the wrist is also helpful in establishing the diagnosis.
Treatment of Scaphoid Fractures
Most scaphoid fractures may be treated in a cast for a period of 8 weeks. The fracture may be slow to heal and immobilisation in a cast may be necessary for up to 12 weeks. There is a small risk that the fracture may not heal or that one of the broken fragments bone loses its blood supply as a result of the injury, a process known as avascular necrosis. If such a complication ensues then surgery may be necessary.
Surgery for scaphoid fractures
In recent years primary surgery for scaphoid fractures utilising specially designed screws inserted with x-ray guidance has been undertaken. Internal fixation of the scaphoid has the advantage of obviating the need for a cast and allowing early gentle wrist movement. Surgery may also be required if the scaphoid does not heal (non-union) or when part of the bone has lost its blood supply as a result of the injury (avascular necrosis).