Scaphoid Fracture of the Wrist

Overview

What is a scaphoid fracture of the wrist?

A scaphoid fracture is a break in a small bone on the thumb side of your wrist. This is also called a navicular fracture. Of the eight carpal bones in your wrist, your scaphoid bone is the one most likely to break.

It is important to find out if you have a scaphoid fracture, because these fractures need treatment to heal well. With proper treatment and follow-up, most scaphoid fractures will heal over time. Without treatment, and sometimes with treatment, healing can be slow and difficult because parts of the scaphoid bone don't have a good blood supply. If your bone does not heal well, you can have long-term pain, stiffness, or arthritis in your wrist.

What causes it?

Most scaphoid fractures occur when you stretch your hand out in front of you to protect yourself from a fall. They can also occur when your wrist twists severely or is hit very hard. Scaphoid fractures often happen while a person is playing sports, such as football, soccer, or basketball, or during activities, such as in-line skating, skateboarding, or bike riding. They can also occur as a result of a car crash or a fistfight.

What are the symptoms?

Because most scaphoid fractures do not cause the wrist to look broken and many cause only minor symptoms, it can be hard to know if your scaphoid bone is broken. If the bone is broken, you may have:

• Pain, tenderness, or swelling on the thumb side of your wrist.
• A hard time grabbing or gripping things or moving and twisting your wrist or thumb.
• Bruises around your wrist.

It can be hard to tell the difference between a wrist that is sprained and one that is broken. If you have fallen on an outstretched hand and your wrist hurts, be sure to see a doctor to find out if you have any broken bones. Scaphoid fractures that are not treated properly can lead to long-term problems.

How is it diagnosed?

Your doctor will ask you questions about your symptoms and about how and when you hurt your wrist. Your doctor will then look at your wrist, find any swollen or tender areas, and see how well you are able to move your wrist and thumb. Your doctor will also try to find out how well blood is flowing to your hand and if you have any nerve damage in your wrist.

Most likely, your doctor will order X-rays of your wrist. Sometimes an X-ray clearly shows a scaphoid fracture. Other times, an X-ray may not show signs of a fracture. If your doctor is not sure if your wrist is broken, you may be referred to an orthopedist, a doctor who specializes in bone problems. Because fractures can't always be seen right away, you may need a follow-up X-ray in 1 to 2 weeks. In the meantime, to prevent possible long-term problems, you will be treated as if you do have a fracture.

In some cases, other imaging tests such as MRIs, CT scans, and bone scans are used to look for scaphoid fractures.

How is a scaphoid fracture of the wrist treated?

Treatment for scaphoid fractures includes wearing an arm cast or splint and sometimes having surgery. Even if the first X-rays or other imaging tests do not show a fracture, your doctor still may treat you to prevent possible problems with healing.

Right after the injury, you may wear a splint because your wrist is too swollen to put a cast on. You may also wear a splint if it is not clear whether your bone is broken. For the first few days, your doctor may tell you to keep your wrist higher than the level of your heart and to use cold packs or ice to reduce swelling. Your doctor may also prescribe a pain medicine or suggest a pain medicine that you can buy without a prescription, such as acetaminophen (for example, Tylenol) or ibuprofen (for example, Advil or Motrin). Be safe with medicines. Read and follow all instructions on the label.

In some cases, after the swelling is gone, the splint will be removed and a cast will be put on. The cast may enclose your thumb and may extend above your elbow. Some people only need to wear a cast for 6 weeks, while others may have to wear a cast for several months. How long your wrist takes to heal depends on how serious your fracture is. Regular visits to your doctor will help you to know how well your fracture is healing and learn how to care for your splint or cast.

In other cases, you may need surgery to put pieces of your bone in the proper place or to help your bone heal faster. You may also need surgery if part of your bone has died because it did not get enough blood. If you have surgery, you will need to wear a splint or cast afterward.

Once a splint or cast is removed, your arm or wrist may feel weak or stiff. Your doctor or a physical therapist can teach you exercises to strengthen your arm and wrist.