Scaphoid Fracture: Causes, Diagnosis, and Treatment

What is a Scaphoid Fracture?

A scaphoid fracture is a common carpal bone fracture. Since the scaphoid plays an essential role in wrist movement and stability, any break in this bone can significantly impact daily activities like gripping, typing, and lifting.

Scaphoid fractures often happen when you fall onto an outstretched hand, with the impact forcing the wrist backward. While some fractures heal with proper treatment, others may result in complications like delayed healing or nonunion, where the bone does not heal properly.

Scaphoid Fractures and Nonunions

Not all scaphoid fractures heal easily. When a scaphoid fracture fails to heal within a standard timeframe, it may develop into a nonunion. A nonunion occurs when the bone fragments do not join together as expected, often due to inadequate blood flow to the bone. This can happen more frequently in the proximal pole (closer to the forearm), as this part of the bone receives less blood supply compared to the distal pole (closer to the thumb).

One complication associated with nonunion of the scaphoid is arthritis of the wrist. The nonunion can cause the articular cartilage in the joint to become worn and frayed.

In some cases, a vascularized bone graft may be required to promote healing in nonunions. This procedure uses a piece of healthy bone with its blood supply intact, allowing the graft to support healing where normal blood flow is insufficient.

Causes and Signs of a Scaphoid Fracture

Understanding how scaphoid fractures occur and recognizing the early warning signs can help ensure timely diagnosis and treatment, reducing the risk of complications like nonunion or avascular necrosis.

The Causes of Scaphoid Fractures

Scaphoid fractures commonly occur during:

• Falls onto an outstretched hand (FOOSH injuries)
• Sports-related accidents (like snowboarding, skateboarding, or contact sports)
• Motor vehicle accidents

The scaphoid bone is particularly vulnerable to injury because of its position and role in wrist movement.

Signs and Symptoms of a Scaphoid Fracture

The symptoms of a scaphoid fracture may not always be obvious right away. Some signs to look for include:

• Pain and tenderness on the thumb side of the wrist, especially in the “anatomical snuffbox” (a small depression at the base of the thumb)
• Swelling and bruising around the wrist
• Limited range of motion or discomfort when gripping or moving the wrist

Since some fractures are subtle, they may be classified as occult scaphoid fractures, meaning they don’t always show up on initial X-rays. This makes it crucial to seek medical evaluation if symptoms persist.

Risk Factors

Certain factors can increase your risk of experiencing a scaphoid fracture, including:

• Participation in sports with a high risk of falls, such as snowboarding, skateboarding, or gymnastics
• Age and gender, as young men are at a higher risk due to higher activity levels
• Bone health issues, such as weakened bones from osteoporosis.

Understanding these risk factors may help prevent future injuries, especially if you participate in high-risk activities.

How Scaphoid Fractures Are Diagnosed

Diagnosing a scaphoid fracture can be challenging, especially with occult scaphoid fractures that may not be visible on initial X-rays. If a fracture is suspected, healthcare providers may use:

• Physical exam: Checking for tenderness in the anatomical snuffbox, swelling, and pain with wrist movement.
• Imaging tests: X-rays are the first step, but if the fracture is not visible, an MRI or CT scan may be required to detect hidden fractures.

Quick and accurate diagnosis is essential to avoid complications like nonunion or avascular necrosis—a condition where bone tissue dies due to a lack of blood flow, especially in the proximal pole of the scaphoid.

Treatment Options for Scaphoid Fractures

Treatment for scaphoid fractures depends on the severity and location of the break. Options may include:

Non-Surgical Treatments

• Immobilization: A cast or splint may be used to keep the wrist still, especially for small, stable fractures.
• Monitoring: Follow-up X-rays or scans may be required to ensure the bone is healing properly.

Surgical Treatments

• Internal fixation: For more serious fractures, such as displaced scaphoid fractures, surgery may be recommended. This involves using screws or pins to stabilize the bone while it heals.
• Bone grafts: For waist fractures or fractures with poor blood supply, a vascularized bone graft may be used to promote healing. The graft brings a fresh supply of blood to the affected area.

Surgery may be the most effective option in some cases, especially when non-surgical treatments do not lead to proper healing.

Recovery and Rehabilitation

Recovery from a scaphoid fracture can vary depending on the type and severity of the break. Here’s what to expect:

• Healing Time: Scaphoid fractures take longer to heal than other bones. You may need to wear a cast or splint for 6 months or longer.
• Physical Therapy: After immobilization or surgery, physical therapy may be recommended to restore strength, flexibility, and range of motion in the wrist.
• Avoid Re-injury: Protecting the wrist during sports or high-risk activities is essential to prevent re-injury.

Patients at Georgia Hand, Shoulder & Elbow benefit from expert care throughout their recovery journey. Their specialists provide personalized treatment plans and support at every stage, from diagnosis to rehabilitation.

Get Expert Care for Scaphoid Fractures

If you’re dealing with a wrist injury or suspect a scaphoid fracture, early treatment is essential to avoid complications like nonunion or avascular necrosis. At Georgia Hand, Shoulder & Elbow, patients receive expert care tailored to their needs. Our experienced team serves the Marietta and Atlanta, GA, communities, providing comprehensive care for wrist injuries, including scaphoid fractures.

With personalized treatment plans and access to advanced surgical options like internal fixation and vascularized bone grafts, we are committed to helping patients regain function and mobility. If you’re experiencing wrist pain or injury, schedule a consultation with their team to start your path to recovery!