The scaphoid is one of eight small bones that make up the “carpal bones” of the wrist. It serves to connect two rows of bones – the distal row (closer to the hand)and the proximal row (closer to the forearm). It’s commonly injured simply due to its location.Typically, such injuries occur when a very heavy load is placed on the extended wrist. This could happen during a fall, where the person lands onto their outstretched hand.
Signs and symptoms
Scaphoid fractures are usually fairly painful and there’s likely tobe swelling along the wrist near the base of the thumb.Patients will usually think they’ve simply got a sprained wrist, as scaphoid fractures typically don’t affect movement. They also don’t present with any physical deformity. But that does not mean scaphoid fractures should not be taken seriously; if left untreated they can lead to chronic pain and stiffness and possible serious complications such as non-union or avascular necrosis.
Diagnosing a scaphoid fracture
Scaphoid fracturesare usually diagnosed by x-raying the wrist. In some cases, a scaphoid fracture will not show up on an X-ray until around 10-14 days after the initial injury hence the importance of reviewing a possible fracture within this time frame. Healthcare providersshould recommend putting a thumb splint on to immobilise the wrist if a fracture is suspected. If pain continues, another exam plus a further x-ray may be needed later.
Bear in mind that not all scaphoid fractures show up on x-rays.An MRI may be needed if repeat radiographic imaging is negative, but clinical findings are still in keeping with a scaphoid fracture. These options will give a better view of the shape and alignment of the scaphoid, helping to makea diagnosis or plans for surgery.
Scaphoid non-union fractures
A scaphoid non-union fracture is essentially a wrist fracture that isn’t healing. A fracture that is healing but more slowly than hoped is called a “delayed union” fracture.
Fractures may not be healing correctly due to a number of factors. These include:
- The pattern the fracture is in
- The age of the patient
- Other medical or wrist conditions
- How the hand is used – this could be related to the patient’s profession
- How physically active the patient is
- Whether the patient smokes
Treatment should maximise function in the wrist whilst reducing pain. Surgery is usually required in order to clean out the area around the fracture and to stabilise it with screws or pins. Non-surgical options include anti-inflammatory medication or an injection of cortisone to alleviate the pain. A brace around the wrist may be required for additional support.
Do you feel confident in the diagnosis and treatment of scaphoid fractures?
If you are already working in an advanced practitioner role then PDUK’sWrist and elbow minor injuries: Refresh and refine your skills course could be for you. Run over half a day and worth 4 hours’ of CPD, it’s aimed specifically at registered nurses, paramedics and other healthcare professionals who examine and assess hand injuries (open and closed) on a regular basis, in an acute setting.
Held entirely online, it’s the ideal opportunity to build up your knowledge and skills flexibly and remotely. It’s popular though, so make sure you secure your place ASAP!
Don’t forget we also offer a wide variety of musculoskeletal (MSK) masterclasses listed below, plus our general minor injury course.
Why not browse through the different options today and find the perfect one for you: