A number of small bones make up your wrist. These different bones allow for the level of movement you enjoy while using your wrist. It is one of the few joints in the body that allows you to twist and turn as it does. However, because these bones are so small the bones are not as thick as what you might find in the arm or the leg. The smaller bones open you up to the possibility of injuries. One of the bones found in your wrist is the scaphoid. A scaphoid fracture occurs when the bone is damaged.
When holding your hand out (thumb facing inward), the scaphoid bone is the small wrist bone that is found between your thumb and index finger. It directly connects your forearm to the wrist. It also runs along the carpal tunnel which is a passage that runs between the small bones in the hand and your forearm.
The bones that run along the wrist are referred to as the proximal row. The scaphoid is the largest of these bones (although it is only the size of a cashew, so it is still relatively small when compared to other bones in your body). Next to the scaphoid is the proximal bone, plus the carpal bones. Most of this bone is protected by cartilage. Cartilage is important here as it allows for a smooth movement against the other bones it connects with. As this cartilage wears down, it can cause pain in the wrist.
The scaphoid bone, as well as the other carpal bones, is designed to add support to the hand. It helps with the movement of the wrist, and the other wrist bones, which include the articulates, radius, ulna and the lunate (these are the main bones found within your wrist.
Due to the scaphoid location in the wrist, it opens itself up to injuries, including a scaphoid fracture. In fact, the scaphoid fracture is the most common fracture and bone injury in the wrist because it is connected to two different rows of carpal bones (unlike the other bones in the wrist which connect with only one other row).
This kind of injury takes longer to heal than other fractures. This is because it is difficult to keep the bone stationary and it receives limited blood circulation. It is important to identify the break quickly and to address the problem right away, otherwise it may cause additional damage with the surrounding ligaments. It also increases the chance of developing carpal tunnel syndrome. Many forms of scaphoid fractures require surgery to correct the injury, so when feeling pain in the wrist it is important to seek a diagnosis from a medical professional right away.
What Is a Scaphoid Fracture?
A scaphoid fracture occurs when there is a break in the bone. Should this occur you will experience a high level of pain right around the base of the thumb. This level of pain increases if you try to move your hand. Because the scaphoid is such an important bone within the wrist, it is difficult to avoid this kind of hand movement. Stabilizing the wrist in the event of an injury is essential to both preventing additional pain and further injuring the joint.
In the event of such an injury there are secondary complications often connected with it. Due to the small nature of the bone, the amount of cartilage surrounding the bone and its connection with other bones in the wrist, you may experience additional problems like avascular necrosis, arthritis and nonunion of the fracture, which splits the bone essentially into two different bones.
Cause & Effect
A scaphoid fracture can occur when doing just about anything. You can trip and fall and hold out your hand to try to reduce your impact (while protecting the rest of your body). Should this happen all of your weight will go on your hand, which is likely bent and not flush with the wrist. Upon impact all the weight of your body collides with the ground at the wrist which opens you up to injuries within the wrist, like a scaphoid fracture. Boxers may experience an injury if their first is not flush with their forearm and the impact is transferred over to the wrist. This kind of injury is common in an assortment of other athletic activities, such as football and hockey. It is also a common injury in basketball because of the hard playing surface.
The main problem with a scaphoid fracture isn't the size of the bone but instead the amount of blood flow the bone receives. Little in the way of blood flow reaches the wrist. This slows down the healing process. To reduce healing time, you need to increase blood flow, which increases the amount of oxygen reaching the injured part of the body on top the nutrients found in the blood. This lack of blood extends the healing process. Due to this, in the event of many scaphoid fractures it may take up to six months to heal completely.
Sometimes, the break will heal on its own and all you need to do is to give it time for the bone to fuse back together. However, in the event of a complete break, where the bone is snapped into two and one portion of the bone may no longer be flush with the other, it often requires a screw or pin to hold the bone in place. The screw is put in place during surgery. Depend on the kind of screw or pin used to hold the bone together it may be removed during a future doctor visit.
How to Treat
Early signs of an injury to the wrist and the scaphoid is there is a tenderness in the area known as the snuff box. When holding the hand out, the snuff box is the indentation occurring between your thumb and the wrist. Tenderness in this area occurs when you have suffered a scaphoid fracture.
There are three different scaphoid fractures, each of which will come with slightly different levels of pain. The first is known as a distal tubercle. This is where the top portion of the bone is cracked off, similar to a chip in a tooth. The second is a wrist fracture. This is when the bone breaks roughly around the middle. The third is a proximal pole which occurs when the bottom portion of the bone is cracked off.
To treat the injury, it is necessary to properly diagnose it. A doctor will probably know when there is a break or fracture within the wrist. However, to know exactly where in the scaphoid the fracture occurred and the extent, you will need an X-ray. At times though the fracture is not immediately apparent. Due to this, you may be placed in a thumb spica splint for up to 10 days. After this amount of time, a hairline fracture will become more apparent (the healing of the two bone fragments is what appears on the new X-ray). In more serious cases where there is a considerable amount of pain and the doctor does not want to wait, a CT Scan may be requested or even an MRI.
Once diagnosed, the scaphoid fracture needs to be positioned back correctly in its original location around the wrist. The two bone fragments need to be seamed back together. Most minimally displaced distal and waist fractures will fuse back together with a simple cast. The cast keeps everything stable and ensures the two bone fragments remain connected. With these injuries, all that can be done is to wait. However, in the event of other fractures, you may need to undergo surgery in order for the wrist to be correctly aligned. More proximal fractures that take place in the middle third of the scaphoid may take upwards of 12 weeks to completely heal, while a larger fracture in the proximal third can take nearly 24 weeks to heal. This is because the scaphoid receives its blood from lateral and distal branches, running top end down, so the lower portion of the bone receives the least amount of blood (it goes to demonstrate the difference between an injury to the top of the scaphoid and the bottom can be at least 12 weeks).
There are some complications with the scaphoid fracture. First, if the bone does not fuse properly together it may require a secondary surgery. If the fracture occurs in the lower portion of the bone, there is a chance it does not receive enough blood, which can prevent the bones from fusing at all.
It is very important for you to seek medical assistance in the event of a wrist injury. Waiting to treat a wrist injury opens you up to secondary problems while reducing the chance of your wrist healing correctly. So if you have any sudden wrist pain, go in and see your medical professional right away.