The wrist is formed by the two bones of the forearm (the radius and the ulna) and eight small carpal bones. The carpal bones are arranged in two rows at the base of the hand.
The scaphoid bone is one of the carpal bones on the thumb side of the wrist, just above the radius. The bone is important for both motion and stability in the wrist joint.Scaphoid fractures account for 70-80% of all carpal bone fractures.
The usual mechanism is falling on an outstretched hand with resultant hyper-extension of the wrist or purely compressive force. Occasionally stress fractures are also encountered although these are less common, and only usually seen in athletes (shot-putters or gymnasts).
Symptoms of a scaphoid fracture typically include pain and tenderness in the area just below the base of the thumb (“anatomic snuffbox”). These symptoms may worsen when you try to pinch or grasp something.
Scaphoid fractures are diagnosed by X-rays however, a non-displaced fracture does not show up on an X-ray when it is taken as early as the first week. In this cases or in displaced fractures, an MRI, or a CT scan can also be ordered to confirm the diagnosis of the scaphoid.
If the fracture is non-displaced, it could be treated by immobilization in a cast. The cast usually covers the forearm, hand, and thumb. Although the fracture may heal in as little as 8 weeks, the healing can often be delayed. One reason for this delay is the variable blood supply to different parts of the scaphoid bone. The fracture can disrupt the bone’s blood supply, impairing the healing.
In this patients, screw fixation surgery (by a percutaneous approach) should be recommended to avoid prolonged casting.
If the fracture is displaced, surgery is more likely to be recommended. Simple, minimally displaced fractures may be better managed with a small operation through a 0,5 mm incision of the wrist to place a screw across the fracture and compress the fragments together. The advantage of this is that the rate of fracture healing is slightly higher and that patient doesn´t need to wear a splint.
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