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of the Hand & Wrist > Fracture of the Scaphoid (Carpal Navicular) What is Fracture of the Scaphoid? A fracture of the scaphoid (which in Greek means boat-shaped) is a fracture of one of the wrist bones near your thumb. This bone, known as both the scaphoid bone and the navicular bone, is located on the inside border of the wrist below the thumb. It is one of the eight bones of the wrist that attach to the bones of the forearm and the bones of the hand, and is the one that is most commonly fractured. Because the scaphoid does not have a good blood supply, fractures to this bone are sometimes difficult to heal. Causes of Fracture of the Scaphoid? A scaphiod (or navicular) fracture is caused by a fall or direct blow to the wrist. Sometimes it is the result of high-energy trauma, such as a car accident. This injury is most common in men between the ages of 20 and 40. It is rarely seen in children, who typically experience injury in the distal radius (one of the long bones of the arm at its edge near the wrist) rather than the scaphoid. The type of accident causing this injury is usually not preventable. Wearing wrist guards during roller-blading or snowboarding helps protect the bones of the wrist, as does the protective gear worn in contact sports such as hockey, football, and boxing. Symptoms of Fracture of the Scaphoid? If you have fractured your scaphoid, you will feel pain and tenderness on the radial (thumb) side of the wrist. Any kind of wrist motion, such as gripping, is painful. The back of the wrist and the area below the thumb usually swell. If you hold your hand in the “hitchhiking position,” you can see the thumb tendons on the back of your hand and thumb. They create a small indented area known as the anatomical snuffbox. When the scaphoid is fractured, there is pain in the snuffbox. Treatment of Fracture of the Scaphoid? As in the case of any suspected fracture, seek medical attention immediately. Many tissues quickly lose their elasticity and must be promptly treated in order to assure maximum healing. Delaying treatment in the case of a scaphoid fracture increases the likelihood that there will be complications in the healing process. If untreated, the pain may subside initially, only to get worse later. Your doctor will examine your wrist, ask for details about the cause of the injury, and review your symptoms. As a scaphoid fracture sometimes does not appear in the first x-ray; a repeat x-ray at one or two weeks may be recommended. Your doctor may advise you to immobilize the injury even if the x-rays appear normal. If x-rays are still normal and yet pain persists after three weeks, your doctor may order a bone scan. It often takes three days after injury before a scaphoid fracture is revealed on a bone scan. The type of cast worn for this injury includes the thumb and may or may not extend above the elbow. It is worn for up to twelve weeks, or even longer depending on the position and complexity of the fracture. In some patient, early screw fixation of scaphoid fractures may be indicated. Having the scaphoid surgery may increase the chance of healing in selected fracture patterns and allow earlier movement when compared to cast treatment. There can be complications in this type of fracture that require additional surgery. In some cases healing does not occur by means of immobilization, and the bones fail to grow back together. This can lead to a problem called avascular necrosis, in which part of the bone dies because of its limited or impaired blood supply. The aim of surgery is to remove part of the injured bone or insert a bone as a graft to help heal the fragment. Appropriate analgesia is used and outpatient pain medication is prescribed. Surgical risk increases with smoking and/or the use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers, and corticosteroids. The goal of rehabilitation is to return you to normal activities and sports as soon as safely possible. Because it can be difficult to determine from routine x-rays whether complete healing of a fracture of the scaphoid has occurred, it is best to err on the side of caution in these cases. Follow-up x-rays should be scheduled for three, six, and twelve months. Your doctor will advise you as to how to exercise all muscle groups that are not immobilized. Muscle contractions in these parts of the hand and arm aid the healing process. Eat a well-balanced diet that includes extra protein such as meat, fish, poultry, cheese, milk, legumes, tofu, and eggs. Everyone recovers from injury at a different rate, and return to normal activities must be determined on the basis of how well your wrist has recovered, not on the length of time that has passed since the injury occurred. The goal of treatment is to develop strength in the injured hand, wrist, and forearm that is as close as possible to that of the uninjured side. There should not be any pain when doing such things as swinging a bat or a racquet, or performing tumbling in gymnastics. It is a good idea to tape the injured wrist or to wear a brace when first returning to competitive sports. Watch carefully for pain and tenderness in the snuffbox area of the wrist, reporting any discomfort to your doctor. The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician. © 2000 DynoMed.com, LLC, Indianapolis, IN |