The scaphoid is one of the small bones of the wrist. It is vulnerable to fracture because of its location and the stress placed across it during a fall. The scaphoid is the second most commonly fractured bone in the wrist, and injuries to this precariously placed bone are extremely common in sporting activities. Most of the scaphoid fractures we see are in younger patients who have had a fall while skiing, snowboarding or cycling. Prompt treatment of scaphoid fractures is critical, as neglecting this injury oftentimes leads to severe wrist arthritis.
Patients who have a scaphoid fracture commonly experience bruising and pain on the thumb side of the wrist after a fall. Patients may have tenderness near the base of the thumb. Pain and swelling in the wrist leads to difficulty with motion, or weakness with grip. Patients with a scaphoid fracture frequently believe that they have sprained their wrist, and we oftentimes see patients with this fracture months after their original injury.
The wrist is made of eight small bones that span between the distal radius and the metacarpals. The scaphoid spans the distance between the two rows of wrist bones. The scaphoid is extremely strong, but its location makes it vulnerable to injury. One of the most important considerations with regard to the scaphoid is its poor blood supply. Fractures of the scaphoid heal slowly, because when it fractures its blood supply may be compromised. If the scaphoid does not heal properly the wrist may suffer from disabling arthritis in the future.
Treatment for scaphoid fractures may be either operative or non-operative. Non-operative treatment involves early splinting of the wrist until the swelling has resolved. Patients are then placed into a cast. The timeframe for casting ranges from six to 12 weeks. Some scaphoid fractures require surgery. This is reserved for displaced fractures, fractures with very bad blood supply, or in patients who cannot tolerate a prolonged cast. Surgery for scaphoid fractures is outpatient, and typically involves placement of a small screw across the fracture, and 2-4 weeks in a cast. Once we have established that the fracture is healing, activity is increased.
After surgery, patients are wrapped in ace bandage and splinted for two weeks. During this time, patients are encouraged to move the fingers and elevate the hand. After two weeks, the wrist is casted and hand exercises are encouraged, but without heavy lifting. At one month we transition our patients into a brace, and gradually increase their activity level. Recovery after cast treatment can be longer as patients are typically casted for a minimum of 8 weeks. After treatment of a scaphoid fracture, most patients are mostly recovered by three months and fully healed by six months.