What is a scaphoid fracture?
Scaphoid fractures are a commonly seen and commonly missed fracture of the wrist. The scaphoid bone is one of 8 bones in the wrist. The wrist joint is divided into two rows and the scaphoid bridges both rows. For this reason, it is extremely important to have a healed and functioning scaphoid. The scaphoid bone, for many reasons, has a poor blood supply. This is because it sits in the joint and has few soft tissue attachments to supply it with blood. Therefore, it is extremely difficult for some scaphoid fractures to heal.
How do scaphoid fractures occur?
Scaphoid fractures occur from a fall on an outstretched wrist. High energy injuries, such as a fall skiing, mountain biking or motorcycling can result in multiple fractures in the wrist.
Scaphoid fractures will present with pain beneath the thumb in an area referred to as the anatomic snuffbox. There will often be swelling, weakness and difficulty putting weight on the wrist. These symptoms may diminish over several weeks. For this reason, patients often do not see a physician after a scaphoid fracture and continue to have mild pain, eventually seeking treatment too late for conservative treatment.
Diagnosing scaphoid fractures
Physical exam will show tenderness in the anatomic snuffbox. There may or may not be swelling. There is pain when putting weigh on the wrist.
X-ray will often make the diagnosis, but MRI and CT scan may be necessary. Many of these fractures do not initially show up on X-ray. This is another reason these fractures are frequently missed.
Nonsurgical Treatment for Scaphoid Fractures
Treatment depends on many factors. Nondisplaced and distal fractures can often be treated in a splint or cast for 6-8 weeks. Healing is slower than most fractures due to the limited blood supply.
Surgical Treatment for Scaphoid Fractures
Displaced and proximal pole fractures often require surgery. Surgery is sometimes performed to stabilize fractures to allow for earlier activity.
Surgery involves screw fixation to create compression across the fracture. Occasionally, bone graft is needed to fill in the space where bone is lost. A vascularized bone graft is a delicate micro vascular procedure that moves a piece of bone along with its blood supply to bring more blood flow to the bone and facilitate healing. Each case is unique and surgical planning involves many factors.
After surgery, the fracture still needs to be protected in a splint or cast until healing occurs. This can take 6-12 weeks. Often, CT scans are needed to access healing.
A scaphoid nonunion is a scaphoid fracture that has not healed. This can occur if a patient does not seek treatment or if it does not heal after surgery. As we discussed, this is due to the blood flow of the bone being poor. A scaphoid nonunion can be a serious condition. If the scaphoid does not heal, wrist arthritis, pain, stiffness, and weakness could occur. Therefore, we typically recommend surgery in scaphoid nonunion. The surgery is as described above but often involves using a bone graft. This may come from the wrist, pelvis or may be a vascularized bone graft. The results of surgery for a scaphoid nonunion may not be as successful as fixing the fracture right away which is why we encourage patients to come in for evaluation at the time of injury.
Schedule a consultation
Board-certified and fellowship-trained hand surgeon Dr. Kavi Sachar is widely regarded as one the nation’s leading experts on scaphoid fractures. Dr. Sachar has three office locations in Vail, Aspen, and Frisco, Colorado. If you or a family member suffer from scaphoid fractures, contact Sachar today. Dr. Sachar is part of the world-renowned Steadman Clinic. Dr. Sachar and his team are here to help.
At a Glance
Dr. Kavi Sachar
- Specializing in Hand, Wrist, & Elbow Surgery
- Board Certified Orthopedic & Hand Surgeon
- Consultant to the US Ski & Snowboard Team & Colorado Avalanche
- Learn more