A fracture of a carpal bone is referred to as a scaphoid fracture. The scaphoid is the most vulnerable bone in the carpal bones and is also known as the scaphoid. In rare cases, a scaphoid fracture can also occur in the foot, as there is also a scaphoid in the tarsal bones there.
What is a scaphoid fracture?
Schematic representation of the anatomy of the hand with a scaphoid fracture. See AbbreviationFinder for abbreviations related to Scaphoid Fracture.
A scaphoid fracture is a fracture of the wrist bones. The scaphoid is located between the radius and the first metacarpal and connects the wrist to the metacarpal. It lies on the thumb side and is located in the first row of the wrists.
A scaphoid fracture is most common in the carpal bones. A scaphoid fracture is relatively difficult to diagnose. Furthermore, so-called pseudoarthrosis, a failure of the bone to heal properly, often occurs.
Both thatwristas well as the ankle have a scaphoid in the root bones. Because of this, a scaphoid fracture can also mean a fracture of the tarsal bones. However, this type of fracture is extremely rare. A scaphoid fracture usually takes up to 12 weeks or more to heal.
Causes
The most common cause of a scaphoid fracture is an accident. The fracture usually occurs as a result of a fall that you try to catch with your hands. You usually fall on your outstretched hand, which is bent backwards on impact.
The scaphoid is pinched between the radius and the other carpal bones. The scaphoid fractures when subjected to great force. A scaphoid fracture often occurs in the context of a car accident. In the event of a collision, you support yourself with your hands on the steering wheel. The affected person often suffers a fracture of the scaphoid bone.
Symptoms, Ailments & Signs
If a scaphoid fracture occurs, there is immediate severe pain in the wrist area. The discomfort occurs mainly in the vicinity of the thumb and increases when the hand and fingers are moved. The fracture is associated with swelling or bruising, with external injuries there is skin damage and bleeding.
The scaphoid fracture symptoms mentioned are mostly unspecific and can also have other causes. A clear sign is the severe pain that occurs when pressure is applied to the wrist. If the joint is touched at the site of the fracture, an acute stabbing sensation occurs, which can radiate to the hand and forearm. If no treatment is given, the pain can become so severe that nausea and circulatory problems can occur.
The movement restrictions are also a clear indication of a fracture. Normally, the hand can no longer be moved or can only be moved to a limited extent, which results in a relieving posture. Above all, the gripping movement of the hand is considerably restricted. In some cases, there are disturbances of sensitivity and symptoms of paralysis. If nerves are injured, complete paralysis of the affected hand can result.
Diagnosis & History
The scaphoid fracture is diagnosed by an orthopedist. However, the diagnosis can often be difficult. First, the injured hand is examined for external injuries. This is followed by a mobility test. This involves palpating the hand to determine if movement or pressure is causing pain. In addition, it is clarified whether there is a sensory disorder.
After the visual and palpation examination, X-rays are taken in four planes, although these do not always reliably represent a scaphoid fracture. Because of this, a computed tomography is usually also made. This also gives an indication of which treatment method (conservative or surgical) is most suitable.
The course of a scaphoid fracture depends on several factors. With a stable fracture and adequate treatment, the scaphoid fracture usually heals without consequences. The healing phase can take up to 12 weeks or more. Complications often occur in the form of pseudoarthrosis, especially in the case of scaphoid fractures that are not discovered or are discovered too late.
Here, the bone heals incorrectly or only inadequately. Healing can also be delayed due to circulatory disorders. A scaphoid fracture can result in a permanent restriction of movement as well as chronic pain.
Complications
Typically, a scaphoid fracture can occur in either the hand or the foot. In both cases, there are restrictions and pain in the patient’s everyday life, so that the quality of life is significantly reduced by this symptom. Most patients also suffer from swelling in the affected areas.
If the scaphoid fracture occurs in the hand, it is no longer possible for the patient to grasp and take it normally. The sensitivity of the hand can also be disturbed by the fracture, resulting in paralysis or tingling. Complications can occur if the scaphoid fracture is not treated. This can lead to irreversible movement restrictions.
The diagnosis of a scaphoid fracture is relatively simple and can be carried out quickly. This means that treatment can be initiated at an early stage. With the treatment itself, there are no special complications. There may also be a circulatory disorder in the affected area.
This disorder also needs to be treated. The life expectancy of the patient is not changed by this fracture. With the help of a plaster cast, the discomfort disappears after a few weeks and the patient can normally use the hand or foot again.
When should you go to the doctor?
After a serious accident, a doctor should be consulted. If the scaphoid is injured in a fall or accident, the doctor must be consulted in any case. Warning signs such as swelling or externally visible bruising must be clarified in any case. Bleeding or even an open fracture also requires immediate diagnosis and treatment by a specialist. This is especially true if the injury limits movement or causes other complications.
If symptoms of paralysis or sensory disturbances become noticeable in the affected part of the body, a doctor must be consulted. A scaphoid fracture usually heals quickly and without complications if it is treated early. Nevertheless, consultation with the doctor should be held during recovery. If you experience pain during healing or feel that the bone is not growing together properly, you should see a doctor. The right contact person is the general practitioner or an internist. Seriously injured must be treated in a hospital.
Treatment & Therapy
When treating a scaphoid fracture, the immediate measures recommended are elevation of the hand, cooling with cool packs and protection of the hand.
Computed tomography can be used to see how and where the navicular bone is broken. Based on this, a decision is then made as to whether conservative treatment is required or whether an operation is necessary.
In the case of a stable scaphoid fracture, a plaster or plastic bandage is applied after the swelling has subsided, which must be worn for up to 12 weeks. Usually the hand, thumb and forearm are in plaster. If the bone parts are displaced in the case of a scaphoid fracture, an operation is usually required. The scaphoid is fixed with several screws.
During the healing phase, X-rays must be taken regularly for control. These serve to monitor the healing process. It is also checked whether there is a circulatory disorder. The treatment of a scaphoid fracture can take a long time and, under unfavorable circumstances, can result in consequential damage. After the plaster cast has been removed, physiotherapeutic measures are recommended in the event of a scaphoid fracture. If there is a scaphoid fracture in the tarsal area, the same treatment methods are usually used.
Outlook & Forecast
If the scaphoid fracture is on the foot bone, absolute care must be taken throughout the healing process. In the case of a scaphoid fracture on the hand with immobilization in a cast, light activities can be resumed after about a month.
Since muscles atrophy and tendons shorten during prolonged immobilization, regular physiotherapy must be started after approval by the doctor. In order to achieve quickly visible success, this must also be supplemented at home with gentle exercises from the field of physiotherapy and occupational therapy. However, the therapist’s instructions should always be followed, since excessive stress could lead to a new fracture. As a rough guideline, intensive physical activity should only take place after about six months. A regular X-ray check provides information about the resilience.
If the fracture was fixed without cast immobilization, but instead by means of a small ambulatory attack by inserting a cannulated screw, it can heal faster and thus enables faster resilience.
In order to alleviate the sometimes very severe pain, those affected can also use natural remedies in addition to prescribed medication. Some preparations can be used internally as tea, drops or tablets, but also as a cream to apply directly to the painful area.
Prevention
There are no preventive measures to prevent a scaphoid fracture. You can only take general precautions such as E.g. being mindful on the road, walking only on level ground, avoiding high-risk sports where falls are inevitable.
Aftercare
The aftercare of a scaphoid fracture consists of several steps. First, the wrist is immobilized. The duration of the immobilization can last from one to two days up to six weeks, depending on the type of fracture. For fractures that are more difficult to heal, immobilization may last even longer. This is assessed and decided on a case-by-case basis by the operating doctor.
The stitches on the scar are removed around 12 to 14 days after the operation. There are typically three to seven sutures that need to be removed. Immobilization is carried out using a forearm plaster splint. With the exception of the thumb end joint, the wrist and the remaining thumb joints are shut down by the plaster splint.
The plaster splint is also used at the beginning of non-surgical treatment. To inspect the wound, the cast can be changed two to three times a week for the first few weeks. Once the sutures have been removed, the wrist is immobilized by a removable wrist splint. However, as soon as the splint is removed, full weight bearing should initially be avoided.
The operated hand has to be continually reaccustomed to normal stress. The doctor treating you can use X-rays to say most precisely when full weight bearing is possible again. Sporting activities should be avoided for another three to four months.
You can do that yourself
After a scaphoid fracture, the affected person must first take it easy. The person concerned should take sick leave for at least five to six weeks. Office work can usually be resumed after three to four weeks.
Since the muscles atrophy after the long period of immobilization and the tendons are usually shortened, consistent physiotherapy is indicated afterwards. Outpatient mobilization measures such as physiotherapy or occupational therapy are also necessary and can be supplemented with gentle exercises at home. The doctor will inform the patient about which training methods are useful and promote healing. Strenuous physical activities should be avoided in the first few weeks, otherwise a new fracture can develop relatively quickly and recovery is delayed.
In addition to the prescribed medication, the patient can also try various natural remedies. The pain-relieving devil’s claw, for example, can be taken as a tea or applied as an ointment. After the plaster has been removed, it is allowed to apply ointments and creams to the injury after consulting the doctor. If the scaphoid fracture has not healed after a few weeks, the doctor must be informed.