Scaphoid Fractures of the Wrist: Overview

Scaphoid Fractures of the Wrist: Overview

This video will provide an overview of scaphoid fractures. The scaphoid is 1 of 8 carpal bones in the wrist. The carpal bones lie between the forearm bones and the hand bones. Given its boat-like shape, scaphoid is derived from the ancient Greek word skaphos, which means hollowed-out and was often used to describe a boat. It forms 5 distinct joints between several bones. Because of this, approximately 80% of the bone’s surface is covered with cartilage to protect and cushion all the joint surfaces. This unique cartilage surface area also limits the amount of blood flow that can enter the bone, particularly in the portion of the bone near the radius, called the proximal pole. The blood supply can be further compromised when the bone is broken through the middle.

Because of the poor blood supply, scaphoid fractures are at particular risk of poor healing, or a complication called avascular necrosis, in which the bone tissue dies. Therefore, early and proper diagnosis and management are key to a successful outcome. Scaphoid fractures are the most common fracture in the carpal bones. They occur most commonly in young active males. Falls on an outstretched hand that hyperextends the wrist typically cause these breaks. Direct impact on the bone can cause fractures, such as the force from a steering wheel during a car accident.

Most fractures to the scaphoid are through the waist of the bone and are nondisplaced, meaning they have not moved the bones out of alignment. If a scaphoid fracture is suspected, pain in the wrist, swelling, and difficulty with motion may be seen. Pain is likely found in a location on the wrist called the anatomic snuffbox, which is the historical location where snuff or ground tobacco was held. Another area of pain may be found on the palm side of the scaphoid, over a prominent bump on the bone called the tubercle. Lastly, pain may also be seen when the thumb is pushed towards the wrist. Patients with scaphoid fractures are likely to have all 3 types of pain.

Along with looking for pain in the previous locations, a health care provider will order imaging studies. However, there is not 1 imaging test that accurately diagnoses scaphoid fractures 100% of the time. The diagnosis of scaphoid fractures can be difficult with x-rays alone. Up to 30% of fractures are undetected on initial x-rays, so follow-up imaging may be needed. Other imaging that may be ordered is a CT or MRI. It is essential that the health care provider does not solely rely on imaging but also considers the clinical exam and symptoms to make the diagnosis.

In summary, the scaphoid is an essential bone in the wrist. It is most likely to be injured following a fall on an outstretched hand, and given its poor blood supply, healing may be difficult. A break to this bone can be difficult to see on x-rays alone. Finally, it is important to consider the entire history, exam, and imaging before making a treatment plan.