Scaphoid Fracture – Broken Wrist

The scaphoid bone is situated on the thumb side of the wrist and uniquely spans two rows of wrist bones. This positioning contributes to its status as the most commonly fractured bone in the wrist. Its atypical blood supply can complicate the healing process when a fracture occurs.

Scaphoid fractures are most commonly caused by falls on an outstretched hand. Other potential causes include motor vehicle accidents and sports-related injuries. The healing outcome largely depends on the fracture's location and the degree of displacement of the bone fragments. Breaks closer to the thumb (distal pole) have better blood supply and healing potential, whereas fractures in the middle (waist) or nearer to the forearm (proximal pole) may experience healing difficulties due to poorer blood flow.

Tenderness directly over the scaphoid is a key symptom of a fracture, typically felt in the area known as the "anatomic snuffbox." Pain may worsen with thumb movement or gripping activities. Initially, pain might subside over a few days or weeks, but scaphoid fractures often do not present with bruising or significant swelling, leading to their frequent misidentification as sprained wrists.

To diagnose a scaphoid fracture, a doctor will examine the wrist and may order X-rays. If initial X-rays do not reveal a fracture, they may be repeated later, or advanced imaging techniques like computed tomography (CT) scans or magnetic resonance imaging (MRI) may be employed, as these methods provide more detailed images. CT scans are particularly useful for assessing fracture displacement.

Treatment options are determined by the fracture's type and location. Fractures near the distal pole generally heal effectively with casting. However, fractures with poor blood supply or those that are displaced typically require surgical intervention.

For scaphoid fractures, surgery can often be performed through a small incision if the bone fragments do not require manipulation. If manipulation is necessary, a slightly larger incision at the base of the thumb may be needed. The surgical approach is based on the fracture's location. Headless screws, available in various types, are used to stabilize the scaphoid during the healing process, and a cast or splint is worn afterward.

Healing from a scaphoid fracture can take several months. After cast removal, hand therapy will be part of the rehabilitation process. Patients should refrain from gripping, heavy lifting, and contact sports until given the green light from their doctor. Some fractures may heal slowly or not at all, leading to complications like nonunion. In such cases, additional surgery may be required to insert bone grafts, which facilitate healing by providing necessary blood supply or growth factors.