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Scaphoid Facture

The scaphoid is one of the 8 small carpal bones of the hand. The scaphoid is located on the thumb side and is commonly the most easily fractured bone of the hand. It can be palpated (or touched) easily when the hand and thumb are in a “hitch hiking” position. This bone is usually fractured by an impact force through the hand, for example falling onto an outstretched hand and palm, such as bracing oneself from a fall. Scaphoid fractures happen oftentimes with sports participation but is possible to occur outside of sports, if the impact on the wrist and hand is forceful enough.

Causes

  • Fall onto an outstretched hand/palm
  • Impact force through the hand or wrist when bracing oneself

Signs and Symptoms

  • Pain at the base of the thumb
  • May be visible swelling at the contour of the thumb and wrist junction (carpometacarpal joint)
  • Pain with movement of the thumb and wrist
  • Pain and difficulty with gripping or holding something

Treatment

The treatment of a scaphoid fracture is dependent on severity and location of the fracture. Fractures that are closer in relation to the thumb have better chance of healing conservatively due to good blood supply. If the fracture is in a location that is closer to the wrist (proximal pole), there is less blood supply and these fractures have to be monitored closely to ensure appropriate healing. Immobilization of the wrist and hand is normally done through the use of a cast or wrist splint until the fracture is healed. Series of X-rays will be done to monitor the healing and determine if continued immobilization is necessary. Complications of fractures located in areas of poor blood supply can include non-union fractures (the bones do not heal together and fragments remain separate) and avascular necrosis (death of the bone due to loss of blood supply). These complications often lead to surgery.

If healing does not occur in an appropriate timeline, surgical intervention is often necessary to secure the fracture (with metal implants, i.e. screws or wires) to aid with proper healing. Following surgical intervention, continued immobilization is necessary until proper healing is noted as seen through X-rays. During this time of immobilization, rest from physical activity is recommended. Once the fracture is healed, it is important to regain full wrist range of motion and strength; this can be done through physical therapy and home exercises.

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