Scaphoid Fracture – Causes, Symptoms & Treatment
A scaphoid fracture is a break of the scaphoid bone in the wrist. It is one of the most common wrist injuries and requires prompt diagnosis and treatment to prevent complications.
Things worth knowing about "Scaphoid fracture"
A scaphoid fracture is a break of the scaphoid bone in the wrist. It is one of the most common wrist injuries and requires prompt diagnosis and treatment to prevent complications.
What Is a Scaphoid Fracture?
A scaphoid fracture is a break of the scaphoid bone (also called the navicular bone), one of the eight small carpal bones in the wrist. Located on the thumb side of the wrist, the scaphoid plays a key role in wrist stability and motion. Scaphoid fractures are the most common carpal bone fractures and are frequently missed on initial X-rays, making them a diagnostic challenge in clinical practice.
Causes and Mechanism
Scaphoid fractures typically result from an indirect injury mechanism, most commonly a fall on an outstretched hand (FOOSH mechanism). Common scenarios include:
- Sports and recreational accidents (e.g., cycling, skiing, skateboarding)
- Falls in everyday life or on slippery surfaces
- Road traffic accidents
- Direct impact trauma to the wrist
The injury most commonly affects young, physically active males between the ages of 15 and 40.
Symptoms
Symptoms of a scaphoid fracture can be subtle, which is why the injury is often mistaken for a simple wrist sprain. Common signs include:
- Pain in the anatomical snuffbox (the small hollow on the thumb side of the wrist)
- Swelling and tenderness around the wrist
- Reduced range of motion in the wrist
- Pain that worsens with gripping or twisting movements
- Occasional bruising around the wrist
A hallmark clinical sign is tenderness in the anatomical snuffbox, which should always be assessed when a scaphoid fracture is suspected.
Diagnosis
Diagnosing a scaphoid fracture can be challenging, as it may not be visible on initial X-rays, especially within the first few days after injury. The following diagnostic methods are used:
- X-ray of the wrist in multiple projections (first-line investigation)
- Magnetic Resonance Imaging (MRI): Gold standard for inconclusive X-ray findings; detects fractures and avascular necrosis early
- Computed Tomography (CT): Excellent for assessing fracture geometry and displacement; essential for surgical planning
- Bone scintigraphy: Occasionally used in uncertain cases
When clinical suspicion is high but X-rays are negative, an MRI scan or repeat X-ray after 10–14 days is strongly recommended.
Classification
Scaphoid fractures are classified based on location and stability. The most widely used system is the Herbert classification:
- Type A: Stable fractures (e.g., hairline crack or complete, undisplaced fracture)
- Type B: Unstable fractures (e.g., displaced, oblique, or involving the poles)
- Type C: Delayed union
- Type D: Established non-union (pseudarthrosis)
Treatment
Conservative Treatment
Stable, undisplaced fractures can often be managed conservatively. The wrist is immobilized in a cast or splint for typically 8–12 weeks. Regular imaging follow-up (X-ray or MRI) is necessary to monitor healing progress.
Surgical Treatment
Unstable, displaced, or non-healing fractures generally require surgical intervention. Common procedures include:
- Percutaneous screw fixation: Minimally invasive fixation using a headless compression screw (e.g., Herbert screw), often performed with arthroscopic assistance
- Open reduction and internal fixation (ORIF): For significantly displaced fractures or established non-unions
- Bone grafting: Required in cases of non-union or avascular necrosis of the scaphoid
Complications
An unrecognized or inadequately treated scaphoid fracture can lead to serious complications:
- Non-union (pseudarthrosis): Failure of the fracture to heal, resulting in persistent instability
- Avascular necrosis: Death of bone tissue due to disrupted blood supply, particularly affecting the proximal pole of the scaphoid
- SNAC wrist (Scaphoid Non-union Advanced Collapse): Progressive wrist arthritis as a consequence of untreated non-union
- Chronic wrist pain and permanent loss of function
Prognosis
With timely and appropriate treatment, the prognosis for a scaphoid fracture is generally favorable. Full healing typically takes between 6 weeks and several months, depending on fracture type and management. If the fracture is missed or inadequately treated, the risk of long-term complications increases significantly. Prompt medical evaluation after any fall on the hand is therefore strongly advised.
References
- Browner, B.D. et al.: Skeletal Trauma: Basic Science, Management, and Reconstruction. Elsevier, 5th edition, 2014.
- Buijze, G.A. et al.: Clinical diagnosis and diagnostic imaging methods for scaphoid fractures. Journal of Hand Surgery, 2012; 37(7): 1426–1433. PubMed PMID: 22727870.
- Clementson, M. et al.: Acute scaphoid fractures: guidelines for diagnosis and treatment. EFORT Open Reviews, 2020; 5(2): 96–103. PubMed PMID: 32175096.
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