WHAT YOU SHOULD KNOW
The scaphoid is the most frequently fractured wrist bone. Many wrist fractures also have wrist ligament injuries that must be treated at the same time. The scaphoid is the most difficult bone in the body to get to heal due to its bad blood supply, location inside a joint, and heavy stresses applied by the neighboring bones. If a scaphoid fracture has 1 mm displacement, the chance of it not healing in a cast is 40%.
MEDICAL HISTORY
Patients may not realize that as serious injury as a wrist bone fracture has occurred. Some think that they have simply sprained their wrists and do not seek treatment soon enough. Pain, stiffness, and swelling all made worse by motion and use are the typical symptoms.
EXAMINATION
Joint motion and strength are measured. Stress evaluation of the wrist ligaments is performed to identify associated ligament injuries if possible. Sometimes tenderness at the fracture location is too much for the patient to tolerate much stress during examination.
ADDITIONAL TESTS
Plain x-rays usually show the fracture well. If not, a CT scan or MRI may be needed for the details.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL FIXATION | |
| CONSISTS OF | Long arm cast followed by a shorter cast | Compression screw in bone and fiber optic examination of ligaments |
| FEATURES | Heavy and interfere with function considerably | Outpatient surgery, minimally invasive, lightweight removable splint |
| ADVANTAGES | Avoids surgery | Motion begins immediately, light activities easy to perform while healing |
| DISADVANTAGES | High chance of not healing, difficult to function while wearing cast | Anesthetic, tiny scar |
RECOVERY
The scaphoid bone can take over 3 months to heal especially if treated non-operatively. The wrist becomes very stiff in a cast and outpatient therapy is required once the cast is removed to then regain motion and strength. Patients stabilized internally with compression screws begin gentle motion exercises immediately after surgery and wear a lightweight removable splint that can be left off during desk type work. Once the bone is proven healed, strengthening and return to sports is allowed, usually after 3 months.
