Scaphoid Fractures

The scaphoid bone is a unique boat-shaped carpal bone, also synonymous with carpal navicular bone. The scaphoid fracture is the most common type of carpal bone fracture. Various factors affect the rate and possibility of bone healing, including the vascularity of the fracture fragments, site of fracture, patient age, smoking, previous surgery etc.

Diagnosis and Differentials of Scaphoid Fractures

Patients usually present with pain over the anatomical snuffbox, or base of thumb. Sometimes, due to the location of the fracture, the pain may be in the distal or dorsal wrist as well.

The scaphoid fracture may not be very clearly seen on routine wrist Xrays. Special views like the semi-pronated or ulnar deviation views are usually performed to better delineate the fracture. (Figure A) A CT scan or MRI may sometimes be required to evaluate the scaphoid to greater resolution.

Figure A

Management of Scaphoid Fractures

Conservative treatment of scaphoid fractures with plaster cast, incorporating the base of the thumb is appropriate for incomplete or undisplaced fractures and selected complete fracture cases.

In cases not suitable for conservative management, surgical fixation is required. Various techniques, such as percutaneous fixation, arthroscopic guided fixation or open fixation techniques, with or without bone graft may be preferred. This should be further discussed with your specialist hand surgeon after studying the imaging studies.

Complications of Scaphoid Fractures

Avascular necrosis is a common complication of a scaphoid fracture. This is dependent on the location of the fracture. Fractures in the proximal pole being at the highest risk, followed by fractures in the waist.

Discuss the different options with the hand specialist looking after you, so that the most appropriate modality is chosen.