The scaphoid bone is one of the eight carpal bones located in the wrist. It is specifically located between the thumb and forearm. The scaphoid bone is the largest bone in the proximal row of carpals and is perhaps the most common to suffer fracture due to traumatic injuries involving the hand. The typical mechanism of scaphoid fracture is to fall onto an out stretched hand (FOOSH injury) while trying to brace yourself from a fall.
Symptoms of a scaphoid fracture typically include pain and tenderness in the area just below the base of the thumb. Symptoms usually worsen upon hand and wrist movement or when you attempt to grasp an object. A scaphoid fracture is classified accordingly to the severity and type of displacement that occurs:
- A non-displaced fracture is seen when the bony fragments remain in close contact and alignment
- A displaced fracture is noted when the fracture has separated the bone segments
Causes Of Scaphoid Injury
Scaphoid fractures may occur in any person at any point during their lives. There are generally no specific risk factors except for bone mineral density problems as seen with Osteoporosis. As discussed the usual mechanism of injury is seen when a person falls onto an outstretched hand with their body weight being applied to the contact hand. This may also result in distal forearm fracture.
Treatment
Advised treatment depends upon the location of the scaphoid fracture, how long ago the injury occurred and whether the fragments are displaced.
- Non-surgical treatment usually involves the application of a wrist brace or plaster cast to immobilize the hand. This allows the fracture to heal. Usual bone healing takes approximately 12 months for the total regain in strength to be seen. Unfortunately the scaphoid has quite a poor blood supply and therefore healing times can be lengthy
- Surgical management of a scaphoid fracture may be recommended to reduce the displacement and to stablize the area. Surgery typically uses screws or implants
To assist in recovery times it is advised to refrain from lifting, carrying, pushing or pulling objects as well as limit throwing or general movement of the arm and hand
Common Complications
- Avascular necrosis is commonly seen with scaphoid injuries due to its poor blood supply. If this occurs, the bone fragments do not receive the appropriate nutrients and cellular death will happen
- Arthritis may occur in surrounding carpal joints of the wrist leading to aching and loss of movement. Chiropractic management can assist with this type of complication and promote normal wrist mobility through stretches, exercises and manual therapy