What is a scaphoid fracture, and how do I manage it?
Scaphoid Fractures: Understanding what they are, management and treatment options
Insight Hand Therapy is a Hand Therapy Clinic located on the Gold Coast, providing specific assessment, treatment and active rehabilitation for hand and upper limb injuries / conditions. Telehealth hand therapy services are also offered for those who do not live on the Gold Coast or Northern NSW, or for those who are unable to attend a face-to-face appointment. The below information is intended for general information purposes and should not substitute individualised, medical or therapy advice. Please get in contact with us directly for more information or for an appointment with an Accredited Hand Therapist (as awarded by the Australian Hand Therapy Association).
Scaphoid fractures are common injuries that affect the small scaphoid bone located in the wrist, near the base of the thumb. This little cashew-shaped bone is quite prone to fractures due to its location and the forces that pass through this bone when falling on the outstretched hand. Scaphoid fractures can often go undiagnosed for long periods of time, and also have a higher risk of poor healing compared to other bones in the hand. Early identification and correct management is essential when treating scaphoid fractures. In this blog post, we will review the incidence, mechanism of action, treatment options, rehabilitation, and outcomes of scaphoid fractures, as well as common complications.
Incidence and Mechanism of Injury
Scaphoid fractures are one of the most common fractures in the wrist and they tend to occur more frequently in men than women. The incidence of scaphoid fractures peaks between the ages of 20 and 40 years and is often associated with sports and high impact falls. It is interesting to note that a number of scaphoid fractures are initially missed on X-rays, which can lead to a delay in individuals seeking appropriate treatment (and then an increased chance of fracture non-union!)
Scaphoid fractures often occur as a result of a fall onto an outstretched hand, with the force being transmitted through the palm of the hand to the scaphoid bone. This type of injury is often seen in athletes who participate in high-impact sports such as football or skateboarding. Other mechanisms of injury include direct trauma to the wrist, such as a punch or blow to the back of the hand.
Treatment
The treatment for scaphoid fractures depends on the location of the fracture within the bone, and if the fracture is been displaced or non-displaced. Your treating doctor or hand therapist will be able to tell you if your fracture is likely to heal conservatively with immobilisation (wearing a splint or cast) or if it will require surgery. Usually if the fracture has been displaced, or through the proximal pole of the bone, a surgical opinion will be strongly recommended due to the higher likelihood of avascular necrosis, a common complication of scaphoid fractures.
If the fracture is non-displaced, conservative management with immobilisation is likely indicated. This treatment usually involves immobilisation of the wrist and the thumb with a splint or cast for 8 to 10 weeks. Repeat imaging is usually performed towards the end of this timeframe to ensure the fracture remains stable and to detect early evidence of bony healing. When appropriate, rehabilitation with your hand therapist will commence with gradual weaning from the splint and graded movement and specific strengthening and stability exercises.
If surgery is required, the surgeon may place a small screw within the bone, holding the fracture fragments in place. You will still need to wear a splint or cast for a period of time for protection and to ensure the screw fixation remains in the correct place. The amount of time in the splint or cast will depend on the type of surgery you have had, which part of the bone was affected and other individual factors. Rehabilitation exercises are essential in the management of scaphoid fractures, whether they are managed conservatively or surgically. Your hand therapist will let you know when it is safe to start these exercises, and provide specific exercises to regain your movement and strength. Proprioceptive rehabilitation is also incorporated to regain full functional use of the wrist and hand. It is important to never commence movement of the wrist and thumb without advice from your doctor or hand therapist.
Outcomes
The outcome of scaphoid fractures depends on several factors, including the location and severity of the fracture, the treatment received, and the individual’s compliance with rehabilitation. Non-displaced fractures typically heal well and have good outcomes when treated conservatively. Displaced fractures, however, have a higher rate of non-union and generally require surgery to achieve optimal outcomes. Individuals who smoke tend to have much slower healing rates, and have higher rates of complications.
Complications
One of the most significant complications associated with scaphoid fractures is avascular necrosis (AVN). AVN occurs when the blood supply to the bone is disrupted due to the location of the fracture, leading to bone death. AVN can lead to chronic pain, reduced function and usually requires further surgical intervention. Individuals with scaphoid fractures should be closely monitored for signs of AVN, which may include persistent pain, weakness, and decreased range of motion.
Scaphoid fractures are common injuries that require prompt and appropriate treatment. Conservative management is often preferred for non- displaced fractures, while displaced fractures often require surgical intervention. Rehabilitation is essential for all individuals with scaphoid fractures to minimise the risk of complications and optimise outcomes. With proper diagnosis, treatment, and rehabilitation, individuals with scaphoid fractures can expect good outcomes and a return to their pre-injury level of function.