What is a Scaphoid Fracture?
The scaphoid bone is one of the eight small bones that make up the wrist. In the wrist, there are two rows of bones, one closer to the forearm (proximal row) and the other closer to the hand (distal row). The scaphoid bone is important in connecting the two rows of bones in the wrist. This positioning makes the scaphoid bone the most commonly injured bone in the wrist.
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Scaphoid fractures most commonly occur as a result of a fall onto an open hand.
What are the Symptoms of Scaphoid Fractures?
Initially, it causes pain but the pain quickly disappears within days or weeks. Bruising is rarely seen. There is usually no visible deformity and only minimal swelling. Because there is no deformity, many people with this injury mistakenly assume that they have sprained their wrist and do not see a doctor. This can result in a delay in the diagnosis of a scaphoid fracture. People who have broken this bone may not realize it for months or even years after the event.
How are Scaphoid Fractures Diagnosed?
Most scaphoid fractures are diagnosed with a wrist X-ray. However, if the fracture has not displaced, it may not be visible on early (first week) X-rays. A nondisplaced scaphoid fracture can therefore be misdiagnosed as a “sprain.” Therefore, in a patient with clear tenderness directly over the scaphoid bone (the hollow in the wrist at the base of the thumb or the snuffbox), a scaphoid fracture should be suspected, and if necessary, wrist MRI and CT scans should be performed. In some cases, a bone scan may also be used. CT scans and/or MRI can also be used to evaluate the displacement and configuration of the fracture. Until a definite diagnosis is made, a half-cast is applied to prevent movement of a possible fracture.
Treatment of Scaphoid Fractures
Treatment of Scaphoid Fractures with a Cast
If the fracture has not shifted, a special scaphoid cast that takes in the thumb is performed. The healing time in the cast is between 6-10 weeks and can even be longer. This is because the blood flow to the bone can vary and the blood flow can be disrupted due to the fracture, causing the bone to heal.
Surgery for the Treatment of Scaphoid Fractures
A part of the bone, especially in the part close to the wrist, can break due to the interruption of blood flow, leading to avascular necrosis (death) in that area. If the fracture is in this area or has shifted, surgery should be planned. In the surgery, to help the healing of the bone, a bone graft taken from the patient’s iliac bone is placed on the fracture line and the fracture is fixed with a screw.
To avoid a long-term cast and to achieve a fast recovery, surgery can be planned for fractures that have not shifted, especially in elite and professional athletes.
How is Scaphoid Fracture Surgery Performed?
Surgery for fractures of the scaphoid that have not shifted or have shifted very little is performed by a closed method with one screw. A small incision (0.5 cm) is made in the patient’s wrist, sufficient for the screw to enter, and the fracture is detected with guide rods. The fracture is fixed by sending the screw through the rods.
