Think you might have a fracture on your scaphoid (a small bone on the thumb side)? looking for reliable and comprehensive information on the topic?
Based on my experience as a diagnostic radiographer and through exploration of scientific literature, I have put together this article for you.
Happy reading!😀
Have any questions, remarks, or experiences to share? Feel free to use the comments section at the end of the article! Your input is appreciated! 🙏
Written by Juliet Semakula, a diagnostic radiographer.
💁Disclaimer: no affiliate links.
▶️What does a fractured scaphoid feel like? Signs and Symptoms
Before delving into the various causes and symptoms that can lead to the scaphoid fracture, let us briefly review some anatomy. (Truly just a tiny bit. I promise.)
A bit of anatomy
The scaphoid bone is the largest of the proximal row of carpal bones and sits on the radial side of the lunate. It is a boat-shaped bone that is oriented obliquely with its long axis aligned from the medial portion of the distal radius proximally to the articulation of the 1st and 2nd metacarpals distally. Labelled in the image below.
Articular cartilage covers 75% of the surface of the scaphoid, an important distinction with respect to blood supply and later healing potential.
And there you have it; the anatomy lesson is already complete!
▶️When should you suspect a scaphoid fracture?
A scaphoid fracture usually occurs when you fall onto an outstretched hand, with your weight landing on your palm. The end of the larger forearm bone (the radius) may also break in this type of fall, depending on the position of the hand on landing.
Symptoms of a scaphoid fracture:
🔵Pain in the wrist, on the thumb area.
🔵 Swelling around the thumb area.
🔵Tenderness to touch.
🔵 Inability to move your wrist.
🔵Bruising or discoloration.
⚠️ Caution⚠️! Pain may be a low-intensity activity for some and could be intense for others. We are all different
Because sometimes there is no visible deformity and no difficulty with motion, some people with such injury assume that it is wrist sprain.
When you start feeling these symptoms and they last more than 24 hours then you know you might have a scaphoid fracture.
To avoid under-treatment and over-treatment, accurate and early diagnosis is required to confirm and exclude scaphoid fracture as the diagnosis. So other imaging modalities are recommended.
▶️Can scaphoid fractures go unnoticed?
Yes, scaphoid fracture can go unnoticed given the relatively mild presenting symptoms and sometimes X-ray findings may fail to show the fracture straight away.
MRI is the test of choice for the evaluation of suspected scaphoid fractures in patients with negative radiographs. Sensitivity has been reported at 95–100% and specificity consistently 100%.(Breitenseher ,1997).
▶️Examinations to diagnose a scaphoid fracture?
After a physical exam by your doctor, you will need at least one of a few imaging tests to confirm if you have a fracture and if so, how intense it is.
🟢An x-ray will confirm any scaphoid or other fractures and show how damaged your bones are.
🟢 Magnetic resonance imaging (MRI): An MRI scan will be done to get a complete picture of the damage to your bones and the area around them. This will show them tissue around your bones, too. This is especially important to determine if your muscles and connective tissue are not injured.
🟢CT scan If surgery is needed, CT will be required to know exactly how damaged your bones are. A CT scan will give a more detailed picture of your bones and the surrounding tissue than an X-ray.
Scaphoid fracture seen on x-ray (top left) and CT scan. Image: Slutsky 2016
▶️Is scaphoid fracture serious?
It is important to recognize early if you have fractured your scaphoid because of an increased risk for serious complications such as:
⚡Non-union by this we mean when the scaphoid fracture does not heal properly because of its fragile blood supply.
⚡Avascular necrosis
⚡Osteoarthritis.
In fact, there is a risk that fractures of the proximal scaphoid will completely disrupt the blood supply, causing part of the scaphoid to necrose, or die.
This phenomenon, called “avascular necrosis,” can cause long-term problems in the wrist.
Scaphoid fracture can lead to severe complications like carpal collapse and osteoarthritis.
When this happens, it will be the case of finding ways to manage your pain along with maintaining a functional wrist.
▶️What is the treatment of a scaphoid?
When it’s confirmed you have a scaphoid fracture!
Alternatives of treatment will be carefully explained to you by your doctor and the most appropriate treatment for the type of fracture you have.
Before treatment, your doctor will consider the fracture location to help him decide what treatment is best for you.
➡️Treatment option 1 -Conservative method
If your fracture is minimally displaced at (0.5mm), it will be treated conservatively by immobilisation using a cast or arm splint, union is usually achieved in 6 weeks.
A Scaphoid fracture which is moderate displaced (0.5-1.5mm) can be treated conservatively, but this will require prolonged cast immobilisation for 8 to 10 weeks.
The amount of time you need to wear the cast depends on what part is fractured and whether the bones heals well.
For conservative treatment, aggressive management, and follow-up with a clinical and x-ray or CT scan at three months and early referral of non-united fractures to the ortho clinic to avoid the advanced collapse of the scaphoid. (Almigdad.,2023)
Possible complications
🔴Delayed union means that the bone took or is taking longer to heal then expected.
🔴Avascular necrosis is a temporary or permanent loss of blood supply to the bone.
➡️Surgery option -Internal fixation
If your fracture is at the proximal pole or completely displaced, these fractures are prone to avascular necrosis and may be better treated by open reduction and internal fixation using a screw fixation.
The displaced bone fragments are put back in the correct position, a screw is used to prevent the bone fragments from shifting again. This process is called osteosynthesis and promotes bone healing. (Liau, 2023)
Surgery for a scaphoid fracture with a volar screw position fixation. (Slutsky 2016).
Bone Graft Method
Your surgeon may use a bone graft. A bone graft involves taking bone tissue from another spot in your wrist and inserting it into the fracture. A bone graft can stimulate healing on the surface of the bones.
Post surgery
After surgery your wrist and thumb will be protected in a splint which will be removed in the clinic along with the skin sutures in about 10-14 days.
At this point, a cast or splint will be placed to protect the fracture until healing is noted on x-rays or CT scan.
It is advisable at this stage to avoid heavy lifting, pulling, pushing or gripping for approximately 3-4 months after surgery.
▶️Advantages of surgery treatment:
It provides adequate stability especially in comminution, bone loss or multi-fragmentary fractures.
▶️Possible complications.
The true is the complication rate is exceptionally low because the whole procedure is done in a safe environment but there is potential for:
🩸 Bleeding
🩸Avascular necrosis (AVN)
🩸 Infection on the fracture site.
🩸Nerve injury.
🩸Stiffness problems
🩸Slow bone healing (non-union)
🩸Arthritis.
▶️Why do I feel pain even after months of treatment:
According to scientific publications persistent pain over the fracture site may indicate incomplete or delayed union but may also relate to associated injury.
Still long-term scaphoid soreness is not uncommon even years after a united scaphoid fracture.
In some studies, scaphoid fractures can lead to loss of wrist motion and eventual arthritis.
But you should be assured that Pain, swelling, and stiffness in the wrist gradually improve over time.
Most patients can return to more normal function at about 4-6 months post-operatively, but maximum improvement can take several months.
Arthritis, also known as degenerative joint disease, may develop in the future if the initial injury damages the joint surface.
The main goal is to help you obtain the most function possible after the injury.
▶️How to speed up recovery from a scaphoid fracture:
I will not promise you that there is a quick way to heal up your fracture, but the best ways are to support the health of your scaphoid bone after treatment of a cast or surgery.
⏺️Rest your wrist in a brace, cast, or splint to help reinforce your efforts at immobilising the scaphoid bone.
⏺️ Avoid any activities such as sports that will risk another fall!
⏺️ If you are a smoker, you should quit smoking as this habit can delay bone healing particularly scaphoid and soft tissue.
⏺️Adequate nutrition is important during the healing and recovery process. A diet rich in protein and calcium and an adequate intake of calories per day while your body is healing.
The body has its natural healing mechanisms allowing them to function without interference and following the above tips is important.
▶️How long does a scaphoid bone take to heal?
The healing time of a scaphoid fracture will depend on the type ,treatment, your age plus your over all health.
Nevertheless the average recovery and healing time for non-displaced scaphoid fractures treated with a cast will be approximately 2 months.
Some of the frequently asked question on scaphoid recovery time.
what is the healing time of a scaphoid screw removal?
The healing time may vary, but it will take a few weeks for the wound to heal and for a full hand function to return, You may need physiotherapy to help with some exercises.
what is the recovery time after a scaphoid surgery?
This will depend on the type of surgery performed, but it usually takes 4-6 months post-operatively, but maximum improvement can take several months for the bone to heal
How long does it take for a nondisplaced scaphoid fracture to heal?
It usually take 8 to 12 weeks for the bone to heal.it is important to follow your doctors instructions to help speed up your healing
What is the recovery time after scaphoid bone graft surgery?
The healing time will vary, but it generally takes several weeks for the graft to integrate and the bone to heal.
▶️When can I return to driving?
Here in the United Kingdom, you might not be insured to drive whilst you are wearing a splint or cast. If you are reading this from another country, please contact your driving policy providers.
The health care here in the UK advise you to safely return to driving when:
1️⃣You are no longer using a splint or any type of immobilisation.
2️⃣You can comfortably grip the steering wheel, move the gear stick, pull up the hand brake and activate the indicators.
3️⃣You can perform an emergency stop.
It is difficult to generalise precise time periods for recovery after various injuries because of patient variation. Some patients recover faster, and some patients require longer periods of rehabilitation to recover.
There may be some individuals who should not drive even if they have never had an injury. Overall, returning to driving needs to be assessed on a case-by-case basis, and the patient needs to take responsibility for this decision. (Blair,2002)
So, returning to work will entirely depend on how safe you feel to drive again!
This is what I wanted to tell you about scaphoid fractures, if you have any questions please head to the comments section.
Wishing you a quick recovery! 🙋
Below are some of the scientific publications I have relied on for this article.
📚Sources:
Clementson M, Björkman A, Thomsen NOB. Acute scaphoid fractures: guidelines for diagnosis and treatment. EFORT Open Rev. 2020 Feb 26;5(2):96-103. doi: 10.1302/2058-5241.5.190025. PMID: 32175096; PMCID: PMC7047900.
Slutsky DJ, Herzberg G, Shin AY, Buijze GA, Ring DC, Mudgal CS, Leung YF, Dumontier C. Coronal Fractures of the Scaphoid: A Review. J Wrist Surg. 2016 Aug;5(3):194-201. doi: 10.1055/s-0036-1585414. Epub 2016 Jul 11. PMID: 27574573; PMCID: PMC5001190.
Liau CJ, Liew SK, Arsad SR, Muhammad Nawawi RF, Silvanathan JP. Scaphoid Plate Osteosynthesis in Complex Fractures and Wrist Trauma: A Case Series. Cureus. 2023 Sep 11;15(9):e45067. doi: 10.7759/cureus.45067. PMID: 37842372; PMCID: PMC10568241.
Greitemeyer MJ, Metz VM, Gilula LA, Gaebler C, Kukla C, Fleischmann D, Imhof H, Trattnig S. Radiographically occult scaphoid fractures: value of MR imaging in detection. Radiology. 1997 Apr;203(1):245-50. doi: 10.1148/radiology.203.1.9122402. PMID: 9122402.
Fowler JR, Hughes TB. Scaphoid fractures. Clin Sports Med. 2015 Jan;34(1):37-50. doi: 10.1016/j.csm.2014.09.011. Epub 2014 Nov 25. PMID: 25455395
Rettig AC. Management of acute scaphoid fractures. Hand Clin. 2000 Aug;16(3):381-95. PMID: 10955212.
Puopolo SM, Rettig ME. Management of acute scaphoid fractures. Bull Hosp Jt Dis. 2003;61(3-4):160-3. PMID: 15156820.
Dias JJ, Singh HP. Displaced fracture of the waist of the scaphoid. J Bone Joint Surg Br. 2011 Nov;93(11):1433-9. doi: 10.1302/0301-620X.93B11.26934. PMID: 22058291.
Almigdad A, Al-Zoubi A, Mustafa A, Al-Qasaimeh M, Azzam E, Mestarihi S, Khair Y, Almanasier G. A review of scaphoid fracture, treatment outcomes, and consequences. Int Orthop. 2024 Feb;48(2):529-536. doi: 10.1007/s00264-023-06014-2. Epub 2023 Oct 26. PMID: 37880341.
Amrami KK. Radiology corner: diagnosing radiographically occult scaphoid fractures—what’s the best second test? J Am Soc Surg Hand. 2005;5:134–138. doi: 10.1016/j.jassh.2005.05.001