Scaphoid Fracture of the Wrist

Overview

What is a scaphoid fracture of the wrist?

A scaphoid fracture is a break in a small bone on the thumb side of your wrist. Of the eight carpal bones in your wrist, your scaphoid bone is the most likely one to break.

It is important to find out if you have a scaphoid fracture, because scaphoid fractures need treatment to heal well. With proper treatment and follow-up, most scaphoid fractures will heal over time. Without treatment, and sometimes with treatment, healing can be slow and difficult because parts of the scaphoid bone do not have a good blood supply. If your scaphoid bone does not heal well, you can have long-term pain, stiffness, or arthritis in your wrist.

What causes a scaphoid fracture?

Most scaphoid fractures occur when you stretch your hand out in front of you to protect yourself from a fall. They can also occur when your wrist twists severely or is hit very hard. Scaphoid fractures often happen while a person is playing sports such as football, soccer, or basketball or during activities such as Rollerblading, skateboarding, or bike riding. They can also occur as a result of a car accident or a punching incident.

What are the symptoms?

Because most scaphoid fractures do not cause the wrist to look broken and many cause only minor symptoms, it can be hard to know if your scaphoid bone is broken. If the bone is broken, you may have:

  • Pain, tenderness, or swelling on the thumb side of your wrist.
  • A hard time grabbing or gripping things or moving and twisting your wrist or thumb.
  • Bruises around your wrist.

It can be hard to tell the difference between a wrist that is sprained and one that is broken. If you have fallen on an outstretched hand and your wrist hurts, be sure to see a doctor to find out if you have any broken bones. Scaphoid fractures that are not treated properly can lead to long-term problems.

How is a scaphoid fracture diagnosed?

Your doctor will ask you questions about your symptoms and about how and when you hurt your wrist. He or she will then look at your wrist, find any swollen or tender areas, and see how well you are able to move your wrist and thumb. Your doctor will also try to find out how well blood is flowing to your hand and if you have any nerve damage in your wrist.

Most likely, your doctor will order X-rays of your wrist. Sometimes an X-ray clearly shows a scaphoid fracture. Other times, an X-ray may not show signs of a fracture. If your doctor is not sure if your wrist is broken, he or she may refer you to an orthopedist, a doctor who specializes in bone problems. Because fractures cannot always be seen right away, you may need a follow-up X-ray in 1 to 2 weeks. In the meantime, to prevent possible long-term problems, you will be treated as if you do have a fracture.

In some cases, other imaging tests such as MRIs, CT scans, and bone scans are used to look for scaphoid fractures.

How is it treated?

Treatment for scaphoid fractures includes wearing an arm cast or splint and sometimes having surgery. Even if the first X-rays do not show a fracture, your doctor still may treat you to prevent possible problems with healing.

Right after the injury, you may wear a splint because your wrist is too swollen to put a cast on. You may also wear a splint if it is not clear whether your bone is broken. For the first few days, your doctor may tell you to keep your wrist higher than the level of your heart and to use cold packs or ice to reduce swelling. He or she may also prescribe a pain medicine or suggest a pain medicine that you can buy without a prescription, such as acetaminophen (for example, Tylenol) or ibuprofen (for example, Advil or Motrin).

In some cases, after the swelling is gone, the splint will be removed and a cast will be put on. The cast will enclose your thumb and may extend above your elbow. Some people only need to wear a cast for 6 weeks, while others may have to wear a cast for several months. How long your wrist takes to heal depends on how serious your fracture is. Regular visits to your doctor will help you to know how well your fracture is healing and learn how to care for your splint or cast.

In other cases, you may need surgery to put pieces of your bone in the proper place or to help your bone heal faster. You may also need surgery if part of your bone has died because it did not get enough blood. If you have surgery, you will need to wear a splint or cast afterward.

Once a splint or cast is removed, your arm or wrist may feel weak or stiff. Your doctor or a physical therapist can teach you exercises to strengthen your arm and wrist.

References

Other Works Consulted

  • Bednar MS, Light TR (2003). Hand surgery. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 3rd ed., pp. 525–572. New York: McGraw-Hill.
  • Uehara DT, et al. (2004). Wrist injuries. In JE Tintinalli et al., eds., Emergency Medicine: A Comprehensive Study Guide, 6th ed., pp. 1674–1684. New York: McGraw-Hill.

Credits

Author Jan Nissl, RN, BS
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Tracy Landauer
Primary Medical Reviewer William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
Last Updated November 13, 2008

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