Everything You Need To Know About Relieving a Scaphoid Fracture

If you fall, what do you do? Do you try to stop yourself, or do you go with gravity? Instinct will almost assuredly kick in, causing you to brace yourself by extending an arm and breaking your fall. You may wind up landing safely and having no complications. However, there are times when you experience pain in the hand or thumb area a day or two later. If you fall and have pain as a result, it's a good idea to get checked out in case you have suffered a scaphoid fracture.

Where Is the Scaphoid Bone?

The scaphoid bone is a cashew-sized bone at the top of the wrist. It is right above the radius, one of the long bones of your forearm. To get a general idea of where the scaphoid is located, place your hand palm down on a hard surface. You can either move your thumb out from the rest of your fingers or spread all your fingers. Find the bulge and crevice created by the ligaments in your thumb starting at the base. If you follow that bulge down your hand, you will come to a small crevice at the base of the hand. This crevice is the approximate location of the scaphoid bone. If you've done this experiment with your right hand, it is on the left side of the ligament mentioned above.

The most common cause of an injury to the scaphoid bone is by using the hand to break a fall. Doing so often means a significant amount of force and pressure is applied to your palm and sends a resulting shockwave up to your wrist. In fact, after you fall, you may feel like your wrist is sore, but it may not be unbearable or particularly painful. You may think, at the very worst, you have a bruise or possible sprain.

Symptoms of a Scaphoid Fracture

The main sign that you may have injured your scaphoid is the pain you feel at the base of your thumb. The pain is pretty localized, and you may not equate it with the fall. You will likely experience some degree of swelling, and the area may feel warm to the touch.

The pain will be most intense while you are trying to grab or grip something or move your thumb independently. While feeling some residual soreness after falling is normal (other parts of your body are probably achy, too), the swelling and pain in your wrist is typically an indicator that something more than a bruise was sustained.

Next Steps...

The pain from a scaphoid fracture may range from mild to severe. If you are feeling severe pain, chances are you've already made a trip to the hospital or your doctor. It is when the pain is present but not severe that you may forgo medical treatment. While a "wait and see" approach may not be detrimental to the function of your wrist and hand at the time, if you wait too long you could suffer further injury and long-term consequences.

If the pain is not severe, but it and the swelling are still present a day or two after falling, it is best to get the wrist and hand checked out. Recount the events that led up to the pain. The doctor will undoubtedly order an X-ray of the area to determine if you sprained or fractured anything.

It is not uncommon for a fracture of the scaphoid to not be immediately evident on an X-ray. Depending on other circumstances, such as the severity of pain or other contributing health factors, the doctor may order an MRI which can help detect a fracture quicker, or you may be sent home in a wrist and hand immobilizer with instructions to return for a follow-up X-ray.

Treatment Options for a Fracture

If you have sustained a fracture of the scaphoid, there are a few different ways to treat it. All treatment recommendations will be made by your doctor and are dependent on where in the scaphoid the break is located.

Upper Scaphoid Break

The top-most portion of the scaphoid closest to the thumb is the best place to sustain a fracture due to a significant amount of blood that flows through the bone at this point. Blood flow makes the healing process much quicker because it continually brings oxygen and other nutrients to the site. If your fracture is in this location, there is an excellent chance it will fully heal in just a couple of weeks. Your doctor will probably put a cast on your hand and wrist to keep the area immobilized, but the cast will likely not include your thumb or go past your elbow.

Middle and Proximal Break

The vast majority of fractures of the scaphoid occur in the middle and lower bone (proximal pole). This area of the bone has little blood flow, and recovery will take much longer. There are a few options your doctor may choose at this time, dependent on the exact location of the break and the severity of it.

  1. Cast: Like most broken bones, the scaphoid heals best when immobilized to allow the bones to fuse back together. The cast applied may vary in size depending on the severity of the fracture. In most instances, a cast is applied that will include the thumb. There are times when the cast may also need to be extended to include the index finger and even the elbow.
  2. Surgery: There are instances where the fracture is so great, and the divide between the broken pieces so large, that a cast alone may not be enough. Surgery may be required to get the bone to heal completely. The decision to surgically repair a fracture is never made lightly, and if an orthopedist recommends it, chances are the surgery is warranted.
hand with bandage

Surgical Repair

Surgical repair of the scaphoid involves using wires or screws to put the bone back together physically. In the case of a multiple-fracture situation, where the bone is divided into more than two pieces, a more complicated repair is needed. In these circumstances, a combination of wires and screws may be utilized. The scaphoid bone is not that large, so the mechanism used to put it back together is also not of great size.

Whatever material an orthopedist uses is set in place through an incision in, at or near the scaphoid. The incision may be made on the underside or palm side of the wrist as well, depending on where the break is. The length of the incision is usually not more than 2 inches.

Once the bone is set back together, the wrist is recast. The cast may remain on for up to six months, depending on the repair that was made. The orthopedist will monitor the progress of the fusion throughout this time using X-rays. If a screw is used, the bone will reform over and around it, thereby making removal unnecessary. There are some cases where wire or perhaps pins may have to be removed after the pieces of bone have entirely fused.

It is critical to follow all of the doctor's recommendations during this healing time to prevent further injury or improper healing. Some of the usual limitations after a scaphoid fracture include:

  • No heavy lifting, pulling or pushing
  • No climbing
  • No activities that increase the probability of another fall

  • Improper Healing Leads to Problems

    If you ignored the pain in your wrist and hand long enough because it wasn't too severe, it might have just been a mild sprain. However, it may have been a fracture that has now not healed properly. Perhaps you decided against surgery, and the cast wasn't as useful in aiding in the bone repair. The occurrence of a nonunion can happen even when surgical intervention is conducted. Nonunion means the bones have not reunited successfully, perhaps due to the number of fractures (if the bone was shattered, for instance), or due to a lack of treatment in the case of someone not seeking medical help or not following doctor's orders. A nonunion may cause the portion of the bone still separated to die off, and necrosis can set in. People who suffer scaphoid fractures have the highest rate of necrosis and nonunion than any other type of fracture.

    The result of nonunion or necrosis may lead to permanent and recurring arthritis in the wrist and hand. Signs include:

    • Constant aching of the wrist
    • Pain associated with use like lifting and gripping objects
    •  Inability to move the wrist in a natural fashion

    Doctors can diagnose arthritis using X-rays, and a course of oral medication or steroid injections may be called for. In some cases, surgery may be conducted to remove the arthritic tissue in the wrist which does usually lead to improvement in use and a reduction in pain.

    If you recently fell or had an accident that impacted your hand and you are now having pain or discomfort in the thumb region, it may be a scaphoid fracture. Even if you don't think it's severe, it's a good idea to go to a doctor and get checked out. Preserving the use of that wrist and hand is far more important than trying to save yourself a trip to the doctor.

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