Julian Carlo, MD - Hand & Upper Extremity Surgeon

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a diagram and x-ray showing a scaphoid fracture

Scaphoid Fracture

What is it? 

A scaphoid fracture is a break in a bone of the wrist called the scaphoid.


What causes it?

Scaphoid fractures usually result from trauma such as falls on the hand.


What are the symptoms?

Pain, swelling, and stiffness in the wrist after trauma are typical symptoms. Depending on the nature of the injury and the patient, the fracture can at times be overlooked as a sprain, and the patient may not seek care initially. When scaphoid fractures are missed originally, the bone is at greater risk of not healing. In this scenario the patient will complain of pain in the wrist with range of motion and activity. 


How is it diagnosed?

During a physical exam, tenderness in the snuffbox (between the wrist and the thumb) of the wrist can suggest a scaphoid fracture.  Xrays of the wrist are taken to evaluate for a scaphoid fracture and to rule out other bone or ligament injuries. Sometimes a fracture may not show up on initial xrays. In this case, the wrist is immobilized and repeat xrays can be obtained in about 2 weeks. An alternative approach would be to obtain a CT scan or MRI to better evaluate for a the fracture that cannot be visualized on plain xrays. 


How is it treated?

Because the scaphoid bone has a limited blood supply, fractures tend to have a greater risk of not healing compared to other bones. When the bone doesn’t heal, it can result in pain, stiffness, and even arthritis. The doctor will choose the course of treatment, either surgery or conservative treatment, that minimizes the chance of nonunion, while also taking into account various patient factors. Some fractures, by virtue of their location, because of displacement of the fracture, have a higher risk of nonunion and surgery for stabilization of the fracture with a screw or other hardware is the best option.  If a fracture are favorable in terms of alignment and location, conservative treatment with cast immobilization can yield a high rate of union.  Even with such a fracture, a discussion of surgery is still worthwhile because surgery can offer a higher rate of union, earlier union, decreased need for immobilization, and earlier return to work or sports. 

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