Scaphoid Fracture of the Wrist-OrthoInfo - AAOS Copyright 2016 American Academy of Orthopaedic Surgeons Scaphoid Fracture of the Wrist Information on scaphoid fractures is also available in Spanish: Fractura del hueso escafoides de la muñeca Fractura del hueso escafoides de la muñeca (topic.cfm?topic=A00703). A scaphoid (navicular) fracture is a break in one of the small bones of the wrist. This type of fracture occurs most often after a fall onto an outstretched hand. Symptoms of a scaphoid fracture typically include pain and tenderness in the area just below the base of the thumb. These symptoms may worsen when you try to pinch or grasp something. Treatment for a scaphoid fracture can range from casting to surgery, depending on the fracture's severity and location on the bone. Because portions of the scaphoid have a poor blood supply—and a fracture can further disrupt the flow of blood to the bone—complications with the healing process are common. Anatomy The scaphoid is one of the small carpal bones in the wrist.

Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2016. The wrist is formed by the two bones of the forearm—the radius and the ulna—and eight small carpal bones. The carpal bones are arranged in two rows at the base of the hand. There are four bones in each row. The scaphoid bone is one of the carpal bones on the thumb side of the wrist, just above the radius. The bone is important for both motion and stability in the wrist joint. The word "scaphoid" comes from the Greek term for "boat." The scaphoid bone resembles a boat with its relatively long, curved shape. The scaphoid bone can most easily be identified when your thumb is held in a "hitch-hiking" position. It is located at the base of the hollow made by the thumb tendons. Often referred to as the "anatomic snuffbox," this area is typically the site of tenderness or pain when a fracture occurs. Photograph and x-ray showing the location of the scaphoid in the wrist.

The red arrows indicate the location of the anatomic snuffbox. Top of page Description A scaphoid fracture is usually described by its location within the bone. Most commonly, the scaphoid breaks in its mid-portion, called the "waist." Fractures can also occur at both the proximal and distal ends of the bone. Scaphoid fractures are classified according to the severity of displacement--or how far the pieces of bone have moved out of their normal position: Non-displaced fracture. In this type of fracture, the bone fragments line up correctly. Displaced fracture. In this type of fracture, the bone fragments have moved out of their normal position. There may be gaps between the pieces of bone or fragments may overlap each other. Illustration and x-ray showing a break in the mid-portion, or "waist," of the scaphoid. This is the most common location for a fracture. Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2016.

Top of page Cause A scaphoid fracture usually occurs when you fall onto an outstretched hand, with your weight landing on your palm. The end of the larger forearm bone (the radius) may also break in this type of fall, depending on the position of the hand on landing. The injury can also happen during sports activities or motor vehicle collisions. Fractures of the scaphoid occur in people of all ages, including children.There are no specific risk factors or diseases that make you more likely to experience a scaphoid fracture. Some studies have shown that using wrist guards during high-energy activities like inline skating and snowboarding can help decrease your chance of breaking a bone around the wrist. Top of page Symptoms Scaphoid fractures usually cause pain and swelling in the anatomic snuffbox and on the thumb side of the wrist. The pain may be severe when you move your thumb or wrist, or when you try to pinch or grasp something. Unless your wrist is deformed, it might not be obvious that your scaphoid bone is broken. With some scaphoid fractures, the pain is not severe and may be mistaken for a wrist sprain.

Pain in your wrist that does not go away within a day of injury may be a sign of a fracture—so it is important to see a doctor if your pain persists. Prompt treatment of a scaphoid fracture will help avoid potential complications. Symptoms of a scaphoid fracture often occur in the anatomic snuffbox at the base of the thumb. Doctor Examination Physical Examination During the exam, your doctor will talk with you about your general health and will ask you to describe your symptoms. He or she will want to know how your injury occurred. Your doctor will examine your wrist. With most fractures, there will be tenderness directly over the scaphoid in the anatomic snuffbox. Your doctor will also look for: Swelling The treatment your doctor recommends will depend on a number of factors, including: The location of the break in the bone Whether the bone fragments are displaced How long ago your injury occurred Nonsurgical Treatment Fracture near the thumb. Scaphoid fractures that are closer to the thumb (distal pole) usually heal in a matter of weeks with proper protection and restricted activity. This part of the scaphoid bone has a good blood supply, which is necessary for healing.

For this type of fracture, your doctor may place your forearm and hand in a cast or a splint. The cast or splint will usually be below the elbow and include your thumb. Healing time varies from patient to patient. Your doctor will monitor your healing with periodic x-rays or other imaging studies. For some fractures, a cast that covers the forearm, wrist, and thumb may be used to help keep the bone fragments in place while they heal. Fracture near the forearm. If the scaphoid is broken in the middle of the bone (waist) or closer to the forearm (proximal pole), healing can be more difficult. These areas of the scaphoid do not have a very good blood supply. If your doctor treats this type of fracture with a cast, the cast may include the thumb and extend above the elbow to help stabilize the fracture Bone stimulator. In some cases, your doctor may recommend the use of a bone stimulator to assist in fracture healing. This small device delivers low-intensity ultrasonic or pulsed electromagnetic waves that stimulate healing. Surgical Treatment If your scaphoid is broken at the waist or proximal pole or if pieces of bone are displaced, your doctor may recommend surgery.

The goal of surgery is to realign and stabilize the fracture, giving it a better chance to heal. Reduction. During this procedure, your doctor will administer an anesthetic or anesthesia and manipulate the bone back into its proper position. In some cases, this is done using a limited incision and special guided instruments. In other cases, it is performed through an open incision with direct manipulation of the fracture. For some fractures, your doctor may use a tiny camera called an "arthroscope" to aid in the reduction. Internal fixation. During this procedure, metal implants—including screws and/or wires—are used to hold the scaphoid in place until the bone is fully healed. The location and size of the surgical incision depends on what part of the scaphoid is broken. Sometimes, the screw or wire can be placed in bone fragments with a small incision. In other cases, a larger incision is needed to ensure that the fragments of the scaphoid line up properly. The incision may be made on either the front or the back of your wrist. (Left) This x-ray shows a scaphoid fracture fixed in place with a screw. (Right) This x-ray was taken 4 months after surgery.

The fracture of the scaphoid is healed. Bone graft. In some cases, a bone graft may be used with or without internal fixation. A bone graft is new bone that is placed around the broken bone. It can stimulate bone production and healing. The graft may be taken from your forearm bone in the same arm or from your hip. Top of page Recovery Whether your treatment is surgical or nonsurgical, you may be required to wear a cast or splint for up to 6 months or until your fracture has healed. Unlike most other fractures, scaphoid fractures tend to heal slowly. During this time, unless advanced activity is approved by your doctor, you should avoid the following activities: Lifting, carrying, pushing, or pulling more than one pound of weight Throwing with your injured arm Participating in contact sports Climbing ladders or trees Participating in activities with a risk of falling onto your hand, such as inline skating or jumping on a trampoline Using heavy or vibratory machinery Smoking (which can delay or prevent fracture healing) Some patients have wrist stiffness after scaphoid fractures. This is more common in patients who wear a cast for a long time or require more extensive surgery. It is important to maintain full finger motion throughout your recovery period.

Your doctor will provide an exercise program, and may refer you to a trained hand therapist who will help you regain as much range of motion and strength in your wrist as possible. Despite hand therapy and a great deal of effort by the patient during home therapy, some patients may not recover the same range of motion and strength that they had before their injury. Complications Nonunion A bone that fails to heal is called a "nonunion." Nonunions are more common after scaphoid fractures because the blood supply to the scaphoid bone is poor. Good blood supply to a bone is very important in fracture healing—since blood carries oxygen and nutrients to the site of the fracture to aid in healing. If your scaphoid fracture does not heal, your doctor may consider surgery to insert a bone graft. There are several types of bone grafts. For nonunions, your doctor may use a special kind of graft with its own blood supply (vascularized graft). In the case of a fracture that has collapsed, your doctor may use a structural graft--possibly from your hip. Avascular Necrosis In scaphoid fractures—especially those in which the bone fragments have become displaced—the blood supply to the bone may be disrupted.

If the blood supply to one of the fragments is reduced significantly or lost completely, that fragment of bone will not get enough nutrients and the cells will die. The bone will not heal properly if this occurs. This condition is called "avascular necrosis." A vascularized bone graft is the most effective treatment for this condition—providing the bone has not collapsed significantly or arthritis has not developed in the wrist. Arthritis Over time, nonunion and avascular necrosis of the scaphoid can lead to arthritis of the wrist. Arthritis occurs when the articular cartilage in the joint becomes worn and frayed—sometimes to the point where bone rubs on bone. Symptoms of arthritis in the wrist may include: Aching Decreased range of motion in the wrist Pain with activities such as lifting, gripping, or weight bearing Treatment for arthritis focuses on improving symptoms. At first, this may include taking anti-inflammatory medicine or over-the-counter analgesics, wearing a splint when the wrist is painful, and avoiding activities that aggravate the wrist. Sometimes, a steroid injection into the wrist may help relieve pain. If conservative treatment does not relieve your symptoms, your doctor may recommend surgery. There are many types of procedures that can be performed for wrist arthritis.

Top of page New Developments For specific fracture patterns, some doctors are now using a very small incision —less than 1/2-inch long—to reduce the fracture and to place a screw in the aligned scaphoid. This procedure is performed using a special x-ray machine to help guide the placement of the screw. Additionally, your doctor may insert a small camera called an "arthroscope" into your wrist to look directly at the fracture. This may help with the reduction and the fixation of the bone and will decrease the surgical exposure needed for certain open procedures. Current research centers on different types of bone grafts and bone graft substitutes to speed bone healing. Additional substances, such as Bone Morphogenic Proteins (BMP), are also being evaluated to improve healing potential. Newer types of wrist braces may help prevent injury and better imaging may lead to earlier diagnosis of these difficult fractures. If you found this article helpful, you may also be interested in Nonunions Nonunions (topic.cfm?topic=A00374). Last reviewed: March 2016 Contributed and/or Updated by: Bertrand Jones, MD; Tamara D. Rozental, MD Peer-Reviewed by: Stuart J.

Fischer, MD; Charles D. Jennings , MD; Fraser J. Leversedge, MD; Colin F. Moseley, MD Contributor Disclosure Information AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS "Find an Orthopaedist" program on this website. Copyright 2016 American Academy of Orthopaedic Surgeons Related Articles Scaphoid Bone Anatomy, Definition & Area | Body Maps Your message has been sent. OK We're sorry, an error occurred. We are unable to collect your feedback at this time. However, your feedback is important to us. Please try again later. Close Scaphoid The scaphoid is a carpal bone in the wrist. It sits on the radial or lateral side of the wrist near the thumb. It is the largest bone in the wrist's proximal row. Lunate, triquetral, and pisiform are the remaining bones in the proximal row.

Trapezium, trapezoid, capitates, and hamate are bones in the distal row. This bone has several distinct surfaces: superior, inferior, dorsal, volar, lateral, medial, and distal convex. The superior and inferior surfaces are smooth and convex. The dorsal surface is narrow and rough, accommodating ligament attachment. The volar surface is concave on top with an elevated and rounded lateral end attaching to the transverse carpal ligament. The lateral surface is narrow and rough, attaching to the wrist's radial collateral ligament. The medial surface has two articular facets. One is smaller and flat. The other is larger and concave. Scaphoid fractures are common injuries in vehicular accidents and sports-related injuries. These fractures typically occur when the body falls on an outstretched wrist. Sixty percent of all carpal fractures are scaphoid related. Bone & Joint Bone & Joint H. P. Singh, J. J. Dias Attachment 1.51 MB Introduction The “Scaphoid” (Greek word “skaphe” for boat) is an obliquely oriented bone on the radial side of the wrist, which bridges the distal and proximal carpal rows.

The body of scaphoid is bean-shaped with a dorsal sulcus and a ridge. (Fig. 1) The tubercle is offset from the distal end by about 45°.1 Fig. 1. Four views of the right scaphoid demonstrate the complex shape of the bone. The fracture line depicts the pattern of waist fracture. (With permission from Elsevier, from Compson JP, Waterman JK, Heatley FW. The radiological anatomy of the scaphoid. Part 1: Osteology. J Hand Surg Br. 1994 Apr; 19(2):183-7) R-S: Radio scaphoid articulation, DA: Dorsal apex of the ridge, TUB: Tuberosity, S-L: Scapho lunate articulation, L A: Lateral apex of the ridge, STT: Scapho-trapezio trapezoidal articulation, S-C: Scapho-Capitate joint) It has six surfaces, four of which are articular facets; the dorsal and palmar surfaces are non-articular with multiple arterial foramina.

The blood supply is mainly (75%) from branches of the radial artery that pass through the attachment of capsule to the dorsal ridge and these also supply the proximal pole. In 20% of scaphoids, most of the arterial foramina are in the waist area of the bone with no more than a single foramen in the proximal third.2 Fractures occurring in these scaphoids may therefore be left without adequate blood supply to the proximal pole. Although the scaphoid is mainly intra-articular and covered with cartilage, there are important sites for attachment of ligaments. Along the ulnar aspect of the proximal pole, the scapholunate interosseous ligament joins the scaphoid to the lunate. More radial is the radioscaphocapitate ligament, which has a substantial insertion on the waist of the scaphoid.

At the distal articulation of the scaphoid is the v-shaped scaphotrapezial ligament.3 Mechanism of Injury Extreme dorsiflexion of the wrist with compression of the radial side of the palm commonly causes middle-third scaphoid fractures.4 Falls backward, with a hand directed anteriorly, are most likely to force extreme dorsiflexion.5 Less commonly, forced dorsiflexion against a steering wheel in a motor vehicle accident or a ball forcing the palm dorsally can cause a scaphoid fracture. Rare mechanisms may involve forced palmar flexion of the wrist or axial loading with the hand clenched in a fist.6 Assessment7-10 (Table 1) and Classification11-14 (Table 2) Investigations The standard radiographs for a scaphoid fracture include four views of the wrist: the postero-anterior (PA) with ulnar deviation; lateral; semi-pronated oblique; and semi-supinated oblique. Other authors have suggested even more views15.

Scaphoid waist fractures are best seen on an ulnar deviated angled PA view and true lateral film.15 Dorsal sulcal fractures are best seen on a 45° semi-pronated oblique view on which the fracture line runs from the dorsal apex of the ridge adjacent to the lunate. (Fig.1). Proximal pole fractures are best seen on a 45° semi-supinated oblique view.15 “Clinical” scaphoid fracture (diagnosis not certain) (Fig. 2) A patient who has sustained a dorsiflexion injury, has pain and tenderness on the radial side of the wrist but whose adequate radiographs don’t show a fracture is considered to have a “Clinical” scaphoid fracture. Initial radiographs detect a fracture in 85-90%16 but it can be occult in up to 10-15% of cases.17 Adequate management includes: Advise the patient of the possibility of a fracture and 10% or so rate of non-union. Advise the patient to restrict activity or to use a removable splint to limit wrist, and therefore scaphoid, movement.

Give the patient the option of being treated in a cast with a 3% chance18 of subsequently identifying a fracture, and Review the patient after two or three weeks; if at this interval, clinical signs still suggest a fracture (swelling, tenderness in the anatomical snuff box and more than 20% restriction of grip strength) further radiographs or other imaging is obtained: If it is readily available, Computed Tomography (CT) scan of scaphoid in the sagittal plane can be used to rule out a scaphoid fracture. This is obtained by placing the patient prone in the scanner with the hand above the head, in full pronation and neutral flexion.19 This identifies the true longitudinal axis of the scaphoid20 and can define the location, pattern, and displacement of the scaphoid fracture. A magnetic resonance imaging (MRI) can be used to identify a scaphoid fracture but is more useful for non-specific wrist pain and can detect other associated injuries to the wrist. It is superior to a repeat radiograph21 and bone scintigraphy22 for occult fractures of scaphoid. Another alternative is high-resolution ultrasonography23 to identify cortical disruption.

Radiocarpal effusion, and scapho-trapezium-trapezoid effusion may also indicate a fracture.24 Ultrasonography is user dependent. In acute fractures, Dynamic MRI scans after bolus administration of gadolinium estimates blood flow through bone although it doesn’t measure perfusion. This technique assesses bone marrow vascularity and by implication, scaphoid vascularity.25 There is a no clear correlation between sclerosis seen on plain radiographs and blood flow assessed by dynamic MRI.26 Fig. 2. Diagram showing options and outcomes after a “Clinical scaphoid” fracture. The options are to assume a fracture has occurred and splint accordingly at a risk of over treating, or to investigate and look for a definite fracture. CT/MRI scan is sensitive and specific. (Costs assessed in 2010 in the UK) Treatment The options for treatment of the broken scaphoid include cast immobilisation and surgical fixation. Cast Immobilization Short arm casts with the thumb left free provide adequate immobilisation for scaphoid fractures27 as restriction of wrist motion will prevent movements at the scaphoid fracture site. Such a cast allows the use of the hand and the elbow is not immobilized.

Long-arm casts have offered no advantage over short-arm casts in preventing interfragmentary motion with forearm rotation.28 The position of the wrist in the cast does not affect healing.29 Casting for 6-8 weeks will predictably heal 90% to 95% of scaphoid waist fractures,30,31 but possible patient inconvenience and work restrictions when in the cast have prompted some to advocate internal fixation with a screw.32,33 Undisplaced fractures (Fig. 3) The best approach for a patient with an undisplaced acute scaphoid fracture is to consider patient’s unique circumstances and discuss risks and benefits of both non-operative management and surgery. There are at present six clinical trials34 comparing casting with surgery in acute scaphoid fractures. The rate of bony union for both methods is greater than 90%. Systematic reviews31,35 have found no difference in union rate or time to return to work, and any surgical benefits are transient.

A cost-utility analysis of open reduction and internal fixation (ORIF) versus cast immobilization a long arm plaster36 for acute non-displaced scaphoid fractures showed that casting was less costly than ORIF but surgery reduced immobilization time and patient had a “shorter time off work”. However, patients are exposed to complications with surgery.37 Fig. 3. Diagram showing the options for diagnosis and management of undisplaced scaphoid fractures. CT scans are most useful while operative fixation can allow an early return to activity but at a higher risk of complications Displaced Fractures (Fig. 4) Displaced fractures risk nonunion. They can heal with conservative treatment but malunite. Displaced fractures could benefit from realignment of the fracture fragments followed by stable internal fixation. In most cases, palmar exposure of the scaphoid limits injury to the blood supply of the scaphoid.38 It is easier to address very proximal fractures through a dorsal exposure. The headless screw has become a popular device but the use of alignment jig has been abandoned as it can damage the scaphotrapezial joint. Cannulated screw fixation has become popular for open as well as percutaneous fixation.

Kirschner wires inserted into the each scaphoid fragment as joysticks allow manipulation of the fragments to achieve reduction. In patients with fracture comminution, particularly with compromise of the palmar cortex, primary bone grafting may be needed. The screw must be positioned within the centre of the scaphoid, as the time to healing is shorter. Central screw placement is achieved more consistently with cannulated screws than with Herbert screws.39 Fig. 4. Diagram showing options for diagnosis and management of displaced fractures of the scaphoid. The risk of nonunion and avascular necrosis is higher with displaced fractures; surgery reduces the risk of nonunion. A displaced fracture is considered to be present if there is a fracture gap or degree of displacement ≥ 1 mm. Identify union Assessment of union is by repeat clinical observation and serial radiographs. We believe union is a process rather than a single event at a specific time in the natural history of healing. Time to union is a flawed observation as it depends on when the observer conducts the radiographs or scans.

Radiograph can be unreliable at identifying union and even experienced observers (both surgeons and radiologists) may not consistently agree on scaphoid union on radiographs taken 12 weeks after injury.19 If doubt persists about union, a CT scan of scaphoid will resolve it. Bridging trabeculae across the whole cross-section of the scaphoid on CT scan confirms union and the wrist can be mobilized. Partial union of the scaphoid is common (upto 40%) and with bridging trabeculae across more than 25% of the cross-section of the scaphoid, it progresses to full union without the need for further plaster immobilization.40 Nonunion is the absence of radiographic signs of healing at 12 weeks and a clear gap on a CT scan. Return to activity This has to be individualised to the patient and the personality of the fracture. The patient is advised against contact sport for two to three months and counselled about the risk of refracture. Grip strength and range of movement is initially better in those who undergo surgical fixation compared with those treated in different casts for 8 to 12 weeks but no difference is found after that time.

Prolonged above-elbow cast immobilisation beyond 8 weeks is not well tolerated, especially by younger patients who want to return to work and sports as soon as possible and should be avoided. For athletes, treatment programs have been modified such that standard fiberglass casts are exchanged for soft or padded casts on game days. The soft casts are required to minimise the potential for injury to other athletes. This has not caused healing problems provided treatment is not delayed.41 An alternative approach is internal fixation of minimally or undisplaced fractures, which avoids cast immobilisation. The fixation is not strong enough to allow impact on the hand in contact sports. Fractures of the Proximal Pole of the Scaphoid 5% of all scaphoid fractures involve the proximal pole (proximal fifth of the scaphoid).42 The primary concerns are the small size and avascularity of the proximal fragment. Prolonged immobilization and a high rate (30%) of nonunion have been reported27 so fixation may be favored for these fractures. If the fragment is large, a headless compression screw can be used.

It is critical to obtain good, preferably central, purchase on the proximal fragment, and ideally the screw should be placed orthogonal to the plane of the fracture. If the fragment is too small to accept such a screw, then Kirschner wires can be used to hold the fracture reduced, and sometimes trans-articular fixation is required. Union rate after open reduction and internal fixation is around 66%.43 Outcome After a healed fracture, 20% patients have some pain and tenderness at 1.7-2.6 years but grip strength and wrist movement were nearly normal.44 Marked radiocarpal osteoarthritis developed in only 2% of cases 36 years after a healed fracture and can be associated with pain or weakness; work has shown that osteoarthritis can develop in only 6% of patients who do not have any symptoms on re-examination, compared with three of the seven who had symptoms.45 Complications Nonunion46,47 (Fig.

5) (Table 3) Untreated Nonunion: Asymptomatic patients with an undisplaced, stable non-union should be advised of the possibility of late degenerative changes.48 Osteoarthritis is found in 100% of patients with symptomatic nonunion after 10 year but symptoms do not correlate with the severity of arthritis or the duration of nonunion. Long-term follow-up after untreated scaphoid nonunion has shown radiological osteoarthritis but many patients retain satisfactory function. Treated Nonunion: The overall union rate of scaphoid nonunions treated by Herbert screw and bone grafting was 84% but delayed union and stable nonunions had significantly better union rate (87%) compared with those with unstable nonunions (60%) (Table 3).49 Fig. 5. Diagram showing risk factors, types and management of nonunion of scaphoid fractures. There is a significant risk of nonunion despite surgery. The main determinants for treatment are stability at the fracture site and vascularity of the fracture fragments.

CRPS: Complex regional pain syndrome, PIN: Posterior interosseous nerve, AIN: Anterior interosseous nerve, PRC: Proximal row carpectomy, OA: Osteoarthritis, ROM: Range of motion. Malunion: Malunion is usually a flexion deformity of scaphoid but can be an ulnar translation or pronation of the distal fragment. The effect of malunion of the scaphoid on wrist function remains unclear. In a study on cadavers, the simulated scaphoid malunion reduced wrist extension and this was proportional to the angular deformity.50 Clinical studies have, however, shown that mild malunion is well-tolerated.51,52 Treated nonunion53 can lead to malunion with a humpback scaphoid and this has previously been reported to have a significant impairment of function and restriction of movements but it is not clear whether it leads to early osteoarthritis. Avascularity: Increased radio-opacity of the proximal fragment is thought to represent avascular necrosis of the scaphoid.

There is poor agreement between observers on whether the proximal part of the scaphoid was avascular in radiographs taken 12 weeks after a scaphoid fracture.30 This appearance is a poor predictor of vascularity of scaphoid seen at operation. Vascularity can also be assessed at the time of surgery and by taking a biopsy. Biopsy can, however, be misleading because of the patchy pattern of avascular necrosis and the sample can contain both viable and dead osteocytes.54 Radionuclide bone scanning is sensitive and can reveal early avascular necrosis but is inaccurate in acute fractures and is not quantifiable.55 Gadolinium contrast-enhanced MR imaging quantifies the extent of necrosis of the proximal fragment and has a good correlation with surgical and histologic findings and the subsequent healing of the nonunion.25 Summary We treat almost all our patients with a scaphoid fracture in a below elbow plaster with the thumb free for 6-8 weeks. At that stage, if there is any doubt about union, we get a CT scan and operate if needed.

We consider surgery for displaced scaphoid fractures causing dorsal intercalated segment instability (DISI) deformity, proximal pole fractures, associated perilunate injuries, open fractures, and fractures in multiply injured patients. Other decision-making factors are whether there is a great potential for morbidity from prolonged immobilization, the occupation of the patient, and a clear failure of healing after non-operative treatment of the fracture. References 1. Compson JP, Waterman JK, Heatley FW. The radiological anatomy of the scaphoid. Part 1: Osteology. J Hand Surg Br 1994;19-2:183-7. 2. Gelberman RH, Menon J. The vascularity of the scaphoid bone. J Hand Surg Am 1980;5-5:508-13. 3. Bettinger PC, Linscheid RL, Berger RA, Cooney WP, 3rd, An KN. An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint. J Hand Surg Am 1999;24-4:786-98. 4.

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Articular fractures of the distal scaphoid. J Hand Surg Br 1988;13-1:87-91. 15. Compson JP, Waterman JK, Heatley FW. The radiological anatomy of the scaphoid. Part 2: Radiology. J Hand Surg Br 1997;22-1:8-15. 16. Leslie IJ, Dickson RA. The fractured carpal scaphoid. Natural history and factors influencing outcome. J Bone Joint Surg [Br] 1981;63-B-2:225-30. 17. Hunter JC, Escobedo EM, Wilson AJ, Hanel DP, Zink-Brody GC, Mann FA. MR imaging of clinically suspected scaphoid fractures. Am J Roentgenol 1997;168-5:1287-93. 18. DaCruz DJ, Bodiwala GG, Finlay DB. The suspected fracture of the scaphoid: a rational approach to diagnosis. Injury 1988;19-3:149-52.

19. Bain GI, Bennett JD, Richards RS, Slethaug GP, Roth JH. Longitudinal computed tomography of the scaphoid: a new technique. Skeletal Radiol 1995;24-4:271-3. 20. Sanders WE. Evaluation of the humpback scaphoid by computed tomography in the longitudinal axial plane of the scaphoid. J Hand Surg Am 1988;13-2:182-7. 21. Kukla C, Gaebler C, Breitenseher MJ, Trattnig S, Vecsei V. Occult fractures of the scaphoid. The diagnostic usefulness and indirect economic repercussions of radiography versus magnetic resonance scanning. J Hand Surg Br 1997;22-6:810-3. 22. Fowler C, Sullivan B, Williams LA, McCarthy G, Savage R, Palmer A. A comparison of bone scintigraphy and MRI in the early diagnosis of the occult scaphoid waist fracture. Skeletal Radiol 1998;27-12:683-7. 23.

Hauger O, Bonnefoy O, Moinard M, Bersani D, Diard F. Occult fractures of the waist of the scaphoid: early diagnosis by high-spatial-resolution sonography. Am J Roentgenol 2002;178-5:1239-45. 24. Fusetti C, Poletti PA, Pradel PH, Garavaglia G, Platon A, Della Santa DR, Bianchi S. Diagnosis of occult scaphoid fracture with high-spatial-resolution sonography: a prospective blind study. J Trauma 2005;59-3:677-81. 25. Munk PL, Lee MJ. Gadolinium-enhanced MR imaging of scaphoid nonunions. Am J Roentgenol 2000;175-4:1184-5. 26. Downing ND, Oni JA, Davis TR, Vu TQ, Dawson JS, Martel AL. The relationship between proximal pole blood flow and the subjective assessment of increased density of the proximal pole in acute scaphoid fractures.

J Hand Surg Am 2002;27-3:402-8. 27. Clay NR, Dias JJ, Costigan PS, Gregg PJ, Barton NJ. Need the thumb be immobilised in scaphoid fractures? A randomised prospective trial. J Bone Joint Surg [Br] 1991;73-B:828-32. 28. McAdams TR, Spisak S, Beaulieu CF, Ladd AL. The effect of pronation and supination on the minimally displaced scaphoid fracture. Clin Orthop 2003-411:255-9. 29. Hambidge JE, Desai VV, Schranz PJ, Compson JP, Davis TR, Barton NJ. Acute fractures of the scaphoid. Treatment by cast immobilisation with the wrist in flexion or extension? J Bone Joint Surg [Br] 1999;81-B:91-2. 30. Dias JJ, Taylor M, Thompson J, Brenkel IJ, Gregg PJ. Radiographic signs of union of scaphoid fractures.

An analysis of inter-observer agreement and reproducibility. J Bone Joint Surg [Br] 1988;70-B:299-301. 31. Yin ZG, Zhang JB, Kan SL, Wang P. Treatment of acute scaphoid fractures: systematic review and meta-analysis. Clin Orthop 2007;460:142-51. 32. Slade JF, 3rd, Geissler WB, Gutow AP, Merrell GA. Percutaneous internal fixation of selected scaphoid nonunions with an arthroscopically assisted dorsal approach. J Bone Joint Surg [Am] 2003;85-A (Suppl 4):20-32. 33. Rettig ME, Kozin SH, Cooney WP. Open reduction and internal fixation of acute displaced scaphoid waist fractures. J Hand Surg Am 2001;26-2:271-6. 34. Grewal R, King GJ. An evidence-based approach to the management of acute scaphoid fractures.

J Hand Surg Am 2009;34-4:732-4. 35. Buijze GA, Doornberg JN, Ham JS, Ring D, Bhandari M, Poolman RW. Surgical compared with conservative treatment for acute nondisplaced or minimally displaced scaphoid fractures: a systematic review and meta-analysis of randomized controlled trials. J Bone Joint Surg [Am] 2010;92-A:1534-44. 36. Davis EN, Chung KC, Kotsis SV, Lau FH, Vijan S. A cost/utility analysis of open reduction and internal fixation versus cast immobilization for acute nondisplaced mid-waist scaphoid fractures. Plast Reconstr Surg 2006;117-4:1223-35; discussion 36-8. 37. Arora R, Gschwentner M, Krappinger D, Lutz M, Blauth M, Gabl M. Fixation of nondisplaced scaphoid fractures: making treatment cost effective. Prospective controlled trial.

Arch Orthop Trauma Surg 2007;127-1:39-46. 38. Gelberman RH, Wolock BS, Siegel DB. Fractures and non-unions of the carpal scaphoid. J Bone Joint Surg [Am] 1989;71-A:1560-5. 39. Trumble TE, Clarke T, Kreder HJ. Non-union of the scaphoid. Treatment with cannulated screws compared with treatment with Herbert screws. J Bone Joint Surg [Am] 1996;78-A:1829-37. 40. Singh HP, Forward D, Davis TR, Dawson JS, Oni JA, Downing ND. Partial union of acute scaphoid fractures. J Hand Surg Br 2005;30-5:440-5. 41. Riester JN, Baker BE, Mosher JF, Lowe D. A review of scaphoid fracture healing in competitive athletes. Am J Sports Med 1985;13-3:159-61. 42. Kozin SH.

Incidence, mechanism, and natural history of scaphoid fractures. Hand Clin 2001;17-4:515-24. 43. Cooney WP, Linscheid RL, Dobyns JH, Wood MB. Scaphoid nonunion: role of anterior interpositional bone grafts. J Hand Surg Am 1988;13-5:635-50. 44. Dias JJ, Brenkel IJ, Finlay DB. Patterns of union in fractures of the waist of the scaphoid. J Bone Joint Surg [Br] 1989;71-B:307-10. 45. Duppe H, Johnell O, Lundborg G, Karlsson M, Redlund-Johnell I. Long-term results of fracture of the scaphoid. A follow-up study of more than thirty years. J Bone Joint Surg [Am] 1994;76-A:249-52. 46. Gunal I, Barton NJ, Calli I. Current management of scaphoid fractures : twenty questions answered.

London: Royal Society of Medicine Press, 2002:ix, 110 p. 47. Mack GR, Bosse MJ, Gelberman RH, Yu E. The natural history of scaphoid non-union. J Bone Joint Surg [Am] 1984;66-A:504-9. 48. Inoue G, Sakuma M. The natural history of scaphoid non-union. Radiographical and clinical analysis in 102 cases. Arch Orthop Trauma Surg 1996;115-1:1-4. 49. Gupta A, Risitano G, Crawford RJ, Burke FD. The Ununited Scaphoid:Prognostic Factors in Delayed and Nonunions of the Scaphoid. Hand Surg 1999;4-1:11-19. 50. Burgess RC. The effect of a simulated scaphoid malunion on wrist motion. J Hand Surg Am 1987;12-5 Pt 1:774-6. 51. Forward DP, Singh HP, Dawson S, Davis TR.

The clinical outcome of scaphoid fracture malunion at 1 year. J Hand Surg Eur Vol 2009;34-1:40-6. 52. Dias JJ, Wildin CJ, Bhowal B, Thompson JR. Should acute scaphoid fractures be fixed? A randomized controlled trial. J Bone Joint Surg [Am] 2005;87-A:2160-8. 53. Amadio PC, Berquist TH, Smith DK, Ilstrup DM, Cooney WP, 3rd, Linscheid RL. Scaphoid malunion. J Hand Surg Am 1989;14-4:679-87. 54. Urban MA, Green DP, Aufdemorte TB. The patchy configuration of scaphoid avascular necrosis. J Hand Surg Am 1993;18-4:669-74. 55. Reinus WR, Conway WF, Totty WG, Gilula LA, Murphy WA, Siegel BA, Weeks PM, Young VL, Manske PR. Carpal avascular necrosis: MR imaging.

Radiology 1986;160-3:689-93. Raleigh Hand Center - Scaphoid Fracture Raleigh Hand Center Scaphoid Fracture What is a scaphoid fracture? The scaphoid bone is one of the eight small bones of the wrist, called "carpal bones." The carpal bones are aligned into two functional rows. The scaphoid is critical for the normal functioning and range of motion of the wrist, as it serves as an important link between the two carpal rows. Of all the carpal bones, the scaphoid is the one most commonly fractured (broken). A scaphoid fracture can occur from a variety of causes including sports injuries, falls, and motor vehicle collisions. However, the most common scenario is a fall on an outstretched arm in a young adult. It is common for people to overlook the injury at first. Once the pain and swelling from the injury improve, people may think the injury was only a wrist "sprain." Often the diagnosis is delayed a few weeks or months. What are the problems with scaphoid fractures? Scaphoid fractures have challenged the most skilled orthopaedists for decades.

Bones are alive; like all living tissues, they require a steady supply of nutrients to remain healthy. When the blood supply to a bone is reduced, the bone can become brittle and weak. The scaphoid bone naturally has a poor blood supply, compared to other bones in the body. When the scaphoid bone breaks, the blood supply to a portion of the bone can be impaired. This puts scaphoid fractures at risk for "nonunion" or failure to heal. Additionally, a portion of the bone may die, known as "avascular necrosis." Finally, if the scaphoid fracture does not heal properly, a pattern of wrist arthritis can develop leading to pain, limited wrist range of motion, and decreased function. This condition is termed "Scaphoid Nonunion Advanced Collapse" (SNAC). How is the fracture diagnosed? History, physical exam, and x-rays are important for diagnosing a scaphoid fracture. In some cases the x-rays soon after the injury appear normal, and the diagnosis may be delayed. After 2-3 weeks the fracture becomes clear on x-ray. Both CT scan (as seen in the image below) and MRI can be helpful to evaluate various characteristics of the scaphoid fracture.

Early diagnosis and treatment is important for optimal outcome. What are the treatment options? The treatment plan will depend on the severity of the fracture as noted on the x-rays and the patient’s medical condition, activity level, and desires. Patients who have well-aligned or "non-displaced" fractures may be treated without surgery. This usually requires a cast immobilizing the thumb and wrist for 2-3 months until the fractures heals. Follow-up x-rays are obtained in clinic to evaluate how the fracture is healing. Over 90% of patients treated appropriately in this manner will heal their scaphoid fracture. Therapy is often helpful in improving range of motion and strength after the cast is removed. It may take up to a year for strength and range of motion to improve to maximal, even with therapy. Occasionally people do not regain full range of motion or strength after this injury. In certain cases, patients with non-displaced fractures request surgery to reduce the amount of cast-time required. This approach is still somewhat controversial among orthopaedic surgeons today. Some patients have fractures which are more severe (displaced), and depending on their health and activity level, surgery may be advised.

The goal of surgery is to stabilize the fracture and promote healing of the scaphoid. What is involved with surgery? The surgery is usually performed on an outpatient basis using either regional anesthesia (brachial plexus nerve block) or general anesthesia. Local anesthesia is not sufficient for this procedure. During the surgery, I improve the alignment of the fracture and use an implant to stabilize the fracture fragments. Intra-operative x-ray called fluoroscopy is used to confirm the alignment. In most cases, I use a single screw to stabilize the bone internally. This is called "open reduction and internal fixation." The incision is repaired using skin sutures. Occasionally bone graft is used to improve the fracture alignment and healing potential of the fracture. Bone graft can be taken from the nearby radius bone, the iliac crest bone of the pelvis, or occasionally cadaver bone graft. Surgery does not really "heal" the fracture; it simply stabilizes the scaphoid while the body bridges the fracture site with new bone. This healing process takes months and patience is encouraged. What can I expect after surgery? Rest and elevation of the hand to the level of the heart is very import for the first few days after surgery to reduce swelling.

I encourage gentle finger range of motion to help prevent digit stiffness. Shoulder and elbow range of motion exercises are also important to help prevent stiffness in these joints. The first 2-3 days after surgery can be very painful. Therefore, narcotic pain medications will be prescribed to help reduce the pain. This medication should be weaned as the pain decreases. Your wrist and thumb will be protected in a splint which will be removed in clinic along with the skin sutures at about 10-14 days. At this point, a cast or removable splint will be used to protect the fracture until healing is noted on x-rays or CT scan. I recommend avoiding heavy lifting, pulling, pushing or gripping for approximately 3 months after surgery. Pain, swelling, and stiffness in the wrist gradually improve over time. Most patients can return to more normal function at about 4-6 months post-operatively, but maximum improvement can take 12 months. Recovery time varies among patients, depending on the severity of the injury, possible complications, and pain tolerance of the patient. Sometimes patients have stiffness and "aching" in the wrist after treatment.

Arthritis, also known as degenerative joint disease, may develop in the future if the initial injury damaged the joint surface. My goal is to help each patient obtain the most function possible after the injury. What can I do to improve my results from surgery? Adequate nutrition is important during the healing and recovery process. I recommend a diet rich in protein and calcium and an adequate intake of calories per day while your body is healing. Please do not smoke! This cannot be overemphasized. Not only is tobacco damaging to cardiovascular and pulmonary tissues, it inhibits soft tissue and bone healing, particularly scaphoids. If you smoke, the risk of nonunion, delayed healing, and infection are higher. What are the complications from surgery? Possible complications include bleeding, infection, swelling, stiffness, nonunion, malunion, avascular necrosis, arthritis, implant failure, and damage to the surrounding nerves and blood vessels. A fracture which fails to heal or unite is known as a nonunion. A fracture which heals with deformity is known as a malunion. Other complications are also possible but are uncommon.

Updated 7/27/2011 For additional information Please call our office at 919-872-3171 to make a clinic appointment. Feel free to visit these reliable websites for accurate information: American Society for Surgery of the Hand: American Academy of Orthopaedic Surgeons: This material is intended for general reference only and does not replace an evaluation by a physician. If you or a loved one has a wrist injury, please visit our website or call 919-872-3171 to be evaluated at the Raleigh Hand Center. Copyright 2016 Erickson Hand Surgery Raleigh Hand Center Scaphoid bone | definition of scaphoid bone by Medical dictionary Scaphoid bone | definition of scaphoid bone by Medical dictionary Related to scaphoid bone: lunate bone , trapezoid bone scaphoid bone Etymology: Gk, skaphe + eidos, form; AS, ban either of two similar proximal boat-shaped bones of the hand and the foot.

The scaphoid bone of the hand is slanted at the radial side of the carpus and articulates with the radius, trapezium, trapezoideum, capitate, and lunate bones. The scaphoid bone of the foot is located at the medial side of the tarsus between the talus and cuneiform bones and articulates with the talus, the three cuneiform bones, and occasionally the cuboid bone. Also called navicular bone . scaphoid bone The largest carpal bone in the first row of wristbones. It is on the thumb side of the hand and articulates directly with the radius. Scaphoid Wrist Fracture. Scaphoid fracture information. | Patient 1015 The scaphoid bone is one of the carpal bones in your hand around the area of your wrist. It is the most common carpal bone to break (fracture). A scaphoid fracture is usually caused by a fall on to an outstretched hand. Symptoms can include pain and swelling around the wrist. Diagnosis of a scaphoid fracture can sometimes be difficult, as not all show up on X-rays.

Treatment is usually with a cast worn on your arm up to your elbow for 6-12 weeks. Sometimes surgery is advised. Correct diagnosis and prompt treatment of a scaphoid fracture can help to reduce complications. Some anatomy around your wrist There are two bones in the part of the arm between the elbow and the wrist (the forearm). These bones are called the radius and the ulna. The radius is on the thumb side of the wrist and the ulna is on the little finger side. In the hand, there are eight small bones known as the carpal bones. They are arranged in two rows, one on top of the other. The proximal row is the row that is closest to the arm. In the proximal row are the scaphoid, lunate, triquetrum and pisiform bones. The distal row is the row below this nearest to the hand. In the distal row are the hamate, capitate, trapezoid and trapezium bones. The scaphoid bone is one of the largest of the carpal bones and is on the thumb side of the wrist. It looks a bit like a cashew nut and is roughly the same size.

It links the two rows of carpal bones together and actually helps to stabilise them. The scaphoid bone and the lunate bone connect with the radius at the wrist joint. What is a scaphoid fracture and what is the usual cause? A scaphoid fracture occurs when you break your scaphoid bone. It most commonly happens after a fall on to your outstretched hand. That is, when your palm is flat and stretched out and your wrist is bent backwards as you fall to the ground. Instinctively, you will usually put your hands out in this position for protection if you fall forwards. Sometimes a direct blow to the palm of your hand can cause a scaphoid fracture. Rarely, repeated 'stress' on the scaphoid bone can lead to a fracture. This can occur, for example, in gymnasts and shot putters. Commonly you will fracture only your scaphoid bone but sometimes other bones around the wrist area may be broken at the same time. Scaphoid fractures may be non-displaced (the fragments of the broken bone haven't moved out of position) or displaced (there is some movement of the bone fragments). How common is a scaphoid fracture?

The scaphoid bone is the most commonly broken (fractured) carpal bone. This is because of its size and position in the two rows of carpal bones in the hand. What are the symptoms of a scaphoid fracture? Usually, most people who break (fracture) a scaphoid bone will remember a specific injury or fall. There will be pain around the wrist area after the injury. There may also be some bruising or swelling around the wrist on the affected side. In some people, symptoms may be milder. Quite commonly, people with a scaphoid fracture just assume that they have sprained their wrist and they don't seek medical attention for some time afterwards. The fracture may only be diagnosed when they see a doctor some weeks later because of pain that is not settling or reduced movement around their wrist. How is a scaphoid fracture diagnosed? A doctor will usually suspect a scaphoid break (fracture) by the mechanism of the injury that has happened - for example, a fall on to an outstretched hand. Also, when they examine your wrist and hand, there is a specific point where you are likely to be tender if you have a scaphoid fracture.

This is known as the anatomical snuffbox. It is a depression in your skin on the back of your hand near to the base of your thumb. Movement of your wrist in certain directions may also be painful if you have fractured your scaphoid. It can sometimes be quite difficult to diagnose a scaphoid fracture. However, it is important to recognise and treat a scaphoid fracture as soon as possible because the complication of non-union (see below) is more likely if treatment is delayed. Standard X-rays may not pick up all scaphoid fractures. This is because the scaphoid bone can 'hide' behind the other carpal bones on an X-ray. Special scaphoid view X-rays taken with your hand and wrist in a certain position may help to show up a scaphoid fracture. However, about 2 in every 10 scaphoid fractures may not be seen on X-ray at first. In some cases, a scaphoid fracture will not show up on an X-ray until around 10-14 days after the initial injury. At this time, the healing process will have started in the bone, which will help the fracture site to show up.

So, if a scaphoid fracture is suspected but not confirmed on an initial X-ray, you will usually be treated as if you have a scaphoid fracture (see below). A repeat X-ray may be suggested after 10-14 days. Sometimes, at this time, it is still not clear whether you have had a scaphoid fracture. If this is the case, a CT scan or MRI scan may be suggested to look for the fracture. A radionuclide bone scan is occasionally used as an alternative but this is used less often, as MRI and CT scans are more widely available and expose you to less radiation. There is currently some debate as to whether there is benefit of doing further investigations such as a CT or MRI scan earlier if a scaphoid fracture is suspected but has not shown up on the initial X-ray. You will usually be followed up by an orthopaedic surgeon in the outpatient clinic if a scaphoid fracture is diagnosed or suspected. They will be able to advise whether and when further investigations are needed. What is the treatment for a scaphoid fracture?

If a non-displaced scaphoid break (fracture) is confirmed on X-ray or is suspected, it is usually treated by putting your arm in a cast (commonly referred to as a plaster cast but actually made of fibreglass or another similar synthetic material) up to your elbow. The cast is usually worn for 6-12 weeks until the scaphoid bone heals. In some cases, it may be needed for longer. If a scaphoid fracture is displaced, surgery may be advised. A small screw or a special pin is inserted into the scaphoid bone to hold the bone fragments together in the correct position. This can often be done via a small cut in your skin. Sometimes surgery may be an option for some people even if a scaphoid fracture is non-displaced. The idea is that it avoids you having to wear a cast for a long period of time. In some cases it may remove the need for wearing a cast altogether. Some also argue that it allows normal movement of your wrist to return more quickly than if you had just been treated with a cast. This means that you can return to your usual activities more quickly.

For example, if you are an athlete, a musician, or if there is another reason why you have significant pressure to return to high-level activity quickly, this treatment option may be a consideration. However, this does mean going through a surgical procedure that does carry some small risks. Are there any complications? A scaphoid break (fracture) will usually heal well if it is recognised and treated early. However, occasionally, complications can occur after a scaphoid fracture. These can include the following: Read more blog posts Delayed union or non-union Delayed union occurs when the scaphoid bone has not healed completely after four months of being treated in a cast. Non-union occurs when the scaphoid fracture has not healed at all. In non-union, the bony fragments are still completely separated. Delayed and non-union may be more likely if treatment of a scaphoid fracture is delayed for some reason. So, this is the main reason why a scaphoid fracture needs to be recognised and treated promptly.

However, the exact position of the fracture in the scaphoid bone, whether the fracture is displaced of not, and whether or not there is avascular necrosis (see below) can also affect the healing of a scaphoid fracture. If delayed or non-union occurs, various treatments may be suggested, including wearing a cast for a longer period or surgery to help join the bone fragments together. Surgery may involve a bone graft to help with fracture healing. This is a procedure where bone tissue is taken from another area of bone in the wrist and inserted into the fracture site. Malunion This occurs when the fragments of the scaphoid bone heal in an incorrect position - for example, at a slight angle. If this happens, it may affect the movement of the wrist and lead to pain and problems gripping and holding objects. Malunion may be seen on an X-ray or scans of the scaphoid bone. Surgery is usually needed to correct this complication. The scaphoid bone is re-broken, aligned correctly and a bone graft is used to correct the deformity and encourage healing. Avascular necrosis Most commonly, a fracture occurs at the narrowest part of the scaphoid (known as the waist).

This is where the blood supply enters the scaphoid bone. So, there is a risk that if you have a fracture in this area, it can sometimes stop the blood supply to part of the scaphoid bone, leaving part of the bone without a blood supply. This means that the scaphoid will not be able to heal properly and part of the scaphoid bone 'dies', collapses and breaks up. ('Avascular' refers to having no blood supply and 'necrosis' means death.) If it occurs, avascular necrosis can be seen on an X-ray of the scaphoid bone some months after the initial injury. However, avascular necrosis does not occur with all fractures around the waist of the scaphoid. Osteoarthritis Osteoarthritis can develop some time after a scaphoid fracture in some people. It is more likely if there have been complications of non-union, malunion or avascular necrosis. Further reading & references Baldassarre RL, Hughes TH ; Investigating suspected scaphoid fracture. BMJ. 2013 Mar 27;346:f1370.

doi: 10.1136/bmj.f1370. Ibrahim T, Qureshi A, Sutton AJ, et al ; Surgical versus nonsurgical treatment of acute minimally displaced and undisplaced scaphoid waist fractures: pairwise and network meta-analyses of randomized controlled trials. J Hand Surg Am. 2011 Nov;36(11):1759-1768.e1. doi: 10.1016/j.jhsa.2011.08.033. Mallee WH, Wang J, Poolman RW, et al ; Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs. Cochrane Database Syst Rev. 2015 Jun 5;(6):CD010023. doi: 10.1002/14651858.CD010023.pub2. Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions.

EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions . Original Author: Scaphoid Bone Scaphoid Bone Lewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy ) Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Scaphoid Bone." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images Related Studies (from Trip Database) Open in New Window Ontology: Scaphoid bone (C0223724) Definition (NCI) A nut-shaped bone of the wrist located in the radial site of the hand. It is one of the eight carpal bones. Definition (NCI_CDISC) A nut-shaped bone of the wrist located in the radial site of the hand. It is one of the eight carpal bones. (NCI) Definition (MSH) The bone which is located most lateral in the proximal row of CARPAL BONES.

Concepts Body Part, Organ, or Organ Component (T023) MSH LP34271-4 English Scaphoid bone, Scaphoid, unspecified, Bone of scaphoid, Bone of scaphoid bone, Os scaphoideum, Scaphoid, os scaphoideum, os naviculare manus, scaphoid, scaphoid bone, Bone, Scaphoid, Bones, Scaphoid, Hand Navicular Bone, Hand Navicular Bones, Navicular Bone of Hand, Os Naviculare Manus, Os Scaphoideum, Scaphoid Bone, Scaphoid Bones, SCAPHOID BONE, Navicular bone of forefoot, Navicular bone of hand, Radial carpal bone, Bone structure of scaphoid, Bone structure of scaphoid (body structure), Navicular bone of hand, NOS, Scaphoid bone, NOS French Os scaphoideum, Os naviculare manus, Os scaphoïde du carpe, Os naviculaire, Os naviculaire carpien, Os scaphoïde, Scaphoïde carpien, Scaphoïde Swedish Sc

aphoid Bone - National Library of Medicine - PubMed Health Home > Health A – Z > Scaphoid Bone Scaphoid Bone The scaphoid bone is one of the carpal bones of the wrist .

It is situated between the hand and forearm on the thumb side of the wrist (also called the lateral or radial side). It forms the radial border of the carpal tunnel . It is approximately the size and shape of a medium cashew. PubMed Health Glossary Scaphoid Scaphoid Fractures Fractures of the scaphoid, a bone in your wrist, are not to be taken lightly. This is the only bone of the body that I know of that has an entire book written about how hard it is to diagnose and treat scaphoid fractures, and what to do when a fracture does not heal! Most of the time, a broken bone is obvious. The area around the break may be painful, swollen or deformed. But sometimes a bone can break without your realizing it. That’s can happen to the scaphoid (pronounced "skaf'-oyd"). Some doctors call this bone the "navicular", but this is an older, out of favor term. Many people with a fractured scaphoid think they have a sprained wrist instead of a broken bone because there is no obvious deformity and very little swelling.

The scaphoid bone is located on the thumb side of your wrist, close to the lower arm bones (see the diagram and X-ray at the top of the page). It is shaped like a cashew, which makes it hard to visualize on the x-ray The reason scaphoid fractures have a hard time healing is due to the anatomy of the blood supply to the bone. The blood supply is what keeps the bone alive and allows it to heal. Most of the bone is covered with cartilage, the smooth shiny material that forms the joints and allows the bones to move. Blood vessels cannot enter through the cartilage, they enter only through the bone. Since the scaphoid is mostly covered in cartilage, there is a limited area for the arteries to enter the bone. In the scaphoid, the blood supply to the bone enters from the distal end, that is, the end toward your fingers. This can be a problem for healing, since most fractures occur in the middle or lower portion of the bone. The blood supply to the proximal fragment, that is, the piece that is toward your elbow, may not have any blood supply. Without a blood supply, the bone cannot heal and that fragment may die.

Who gets scaphoid fractures? Scaphoid fractures account for about 60 percent of all wrist (carpal) fractures. They usually occur in men between ages 20 and 40 years, and are less common in children or in older adults. The break usually occurs during a fall on the outstretched hand. It’s a common injury in sports and motor vehicle accidents. The angle at which the hand hits the ground determines the injury. The following is a very rough "rule of thumb": If the wrist is bent at a 90-degree angle or greater, the scaphoid bone will break; if the angle is less than 90 degrees, the lower arm bone (radius) will break. -Pain and tenderness on the thumb side of the wrist. -Motion (gripping) may be painful. -May be some swelling on back and thumb side of wrist. -Pain may subside, then return as a deep, dull aching. -Marked tenderness to pressure on the "anatomical snuffbox," a triangular-shaped area on the side of the hand between two tendons that lead to the thumb.

Diagnosis The diagnosis is based on a history of trauma to the wrist (usually a fall or accident), a clinical exam that shows tenderness in the region of the scaphoid and a painful Watson test (a maneuver in which the wrist is moved back and forth, with the examiner's thumb on your scaphoid; it is just slightly painful), and X-rays that show a fracture. Sometimes, the X-ray does not show a fracture. Usually, with a supportive history and clinical exam, the diagnosis will be made of a probable scaphoid fracture. Treatment Treatment is determined by the fracture site, the degree of displacement, any associated injuries, and the patient's occupation and desires. Cast Treatment Most scaphoid fractures are treated with immobilization in a cast that immobilizes the elbow, wrist, and thumb, for six weeks, and then only the wrist and thumb for an additional six weeks. Healing time, however, can range from six weeks for fractures in the top portion (toward the fingers) to six months or longer for fractures in the lower portion (toward the wrist). The cast must be checked regularly to make sure that it fits properly and prevents movement. After the cast is removed, a rehabilitation program helps restore range of motion and strength.

Surgical Treatment Some fractures are displaced by 1 mm or so. These usually need surgical treatment. Scaphoid fractures that are accompanied by other injuries, usually a distal radius fracture, also need surgery. Also, with newer techniques, the risks of surgery are so low that some patients choose surgery, because it usually means the patient does not need to wear a cast at all, just a splint. Not all scaphoid fractures will heal properly. The usual causes are delay in treatment or too short a time in a cast that is too short. Smoking also interferes with bone healing. However, the scaphoid is rather famous for not healing, even when everything is done properly. Surgery is usually recommended when the scaphoid fails to heal (non-union). Surgery for non-union is successful in approximately 75 percent of cases. Sometimes a bone graft is used to promote healing. Scaphoid fractures often take a long time to heal. Any delay in getting treatment increases the risk of poor healing and the probability of more problems later. An untreated scaphoid fracture can lead to severe arthritis and eventually require surgery to fuse or replace the joint.

Question: Where in the body is the scaphoid bone
Answer: Wrist