What is Scaphoid Fracture?
Scaphoid is one of the most important one of 8 different bones at the wrist joint. Scaphoid bone is a keystone at the mechanical balance of the wrist. If this bone is fractured at the wrist trauma, the stability of the joint is disrupted.
How does scaphoid fracture occur?
If somebody would fall down on an outstretched hand, scaphoid may be broken. The initial pain may decrease in days or weeks. The swelling may not be too much. Since there is no obvious deformity around the wrist, it can be ignored and considered as a simple wrist sprain. For that reason, going to a doctor may delay for weeks or months.
How does scaphoid fracture get diagnosis?
The fracture of the scaphoid is usually seen on the x-ray. However, if it is un-displaced and simple fracture, it may not be noticed at the initial x-rays during the first few weeks. The scaphoid bone is painful on the physical examination. This pain is localized at the snuffbox of the wrist. If it is suspected as a fracture and the initial roentgenograms are normal, using a protective splint is recommended followed by a control appointment after a few weeks for a new x-ray evaluation. However, new high technology advanced imaging modalities such as magnetic resonant imaging and computed tomography may provide early detection of the fracture.
How is scaphoid fracture treated?
if it is un-displaced and simple fracture, it is usually treated with a cast application. Scaphoid bone healing may last a little longer than normal bones. So the cast immobilization may take at least 6 weeks.
When is surgery required?
If the fracture is displaced, then the surgical treatment may take into consideration. In the surgery, the fracture is completely anatomically reduced and fixed with screws or pins.
What are complications in scaphoid fractures?
- Nonunion: If the fracture of the scaphoid is ignored, considered as a simple wrist sprain, and the treatment is delayed, the possibility of bony union would be very low. Sometimes even if proper treatment would be applied, it would not be healed. Nonunion of the scaphoid means both loosing of the structure of the bone and disrupting of the stability of whole wrist joint. All of these changes lead early degenerative arthritis. If scaphoid nonunion is detected before degenerative arthritis develops, the surgical treatment is planned to get union.
- Avascular necrosis: Some part of the bone may loose its vitality because of discontinuity of the vessels which are responsible on feeding of the bone. In that case, the bone becomes deformed. This may also result in arthritis in the middle and long-term time period.
- Degenerative arthritis: If degenerative arthritis has already occurred, then salvage operations is in consideration rather than union surgeries.