A fall caught with the flat of the hand, followed by a painful wrist - a medical examination reveals a scaphoid fracture. In the following article we clarify what is important to better understand the diagnosis.
Our hand is an impressive organ. On the one hand, we can use it to hold on powerfully to a rock when climbing, for example. On the other hand, the fine structure also makes delicate and precise movements possible, such as for sewing or playing the piano. The complex structure of our wrist enables us to optimally perform the many different movements in everyday life. The carpal bones play an important role in the transmission of force and the mobility of the hand. One of the most common injuries to the carpus is the scaphoid fracture .
Anatomy of the carpus and the scaphoid bone
Our wrist is not a single joint, but consists of a total of 8 differently shaped carpal bones , which are arranged in two rows. While one row works together with the radius and ulna, the carpal bones of the second row connect to the metacarpals. Together they enable the most diverse movements of the hand.
In a wrist fracture, therefore, it is not a single specific bone that is affected, but one or more of the 8 carpal bones. In most cases, the scaphoid bone is affected. This bone forms the joint surface to the radius, interacts with 3 other bones and is responsible for the transmission of force to the thumb .
The scaphoid bone (red) is the most frequently affected bone of the eight carpal bones. Causes of a scaphoid fracture
Whether it is a fall in everyday life - slipping on the freshly mopped floor - or a fall during a favourite sport, the fall is often intuitively broken with the outstretched hand. This is a common cause of a scaphoid fracture. During the fall, the navicular bone hits the radius with a lot of force and breaks. Typical sports with an increased risk of this injury include snowboarding, inline skating or mountain biking.
Symptoms: How do I recognise a scaphoid fracture?
A dull pain and swelling in the wrist are the first signs of an injured wrist. However, pain in the wrist can be quite mild and subsides after a while. This can sometimes lead to the fracture being passed over. This can have unpleasant consequences, however, because the fracture heals inadequately without treatment and a so-called false joint may be left behind: the fracture pieces no longer grow together properly and allow mobility in the wrist that was not intended in this way. Over many months or years, such a false joint can develop a Arthrosis pain or restricted movement even years later.
Even in the case of minor pain, the suspicion of a scaphoid fracture should be clarified by a doctor. If the injury is overlooked, the consequences can be pseudarthrosis, which often leads to complaints years later.
If a scaphoid fracture does not heal completely, a so-called false joint can develop, which can lead to pseudarthrosis.
Diagnosis of scaphoid fractures
If a fracture is suspected, the hand is first x-rayed by the doctor in charge. However, a scaphoid fracture is often easy to miss, as fresh, undisplaced fractures in particular are difficult to recognise in X-rays . If the suspicion remains due to the pain and the course of the accident , a CT, a computer tomography , is performed in case of doubt. As long as a fracture cannot be ruled out, the wrist should be immobilised with a forearm cast to be on the safe side, so as not to risk further injury.
How is a scaphoid fracture treated?
If a scaphoid fracture has been diagnosed, treatment can be either conservative or surgical . The decision for one of the two methods depends on various factors. If the fracture is not displaced and the bone pieces are in a favourable position in relation to each other, conservative treatment is more likely to be recommended. Patients are given a forearm cast that also includes the thumb. This is particularly important because movement of the thumb can directly interfere with the healing of the scaphoid.
A forearm cast that also encloses the thumb ensures optimal immobilisation of the scaphoid. Another aspect that contributes to the decision between conservative and surgical treatment is the specific location of the fracture. This is because a special feature that has to be taken into account when healing the scaphoid is the uneven blood supply . The responsible blood vessel only enters in the second half of the bone, so that the half at the radius is only weakly supplied with blood and thus with nutrients. This can make recovery particularly lengthy . In addition, the closer the fracture is to the radius, the more difficult it is to immobilise the wrist consistently. If the fracture is in this area - and unfortunately this is usually the case - surgery is often recommended.
The weak blood supply in the part of the scaphoid lying against the radius (inside the dotted circle) can delay the healing process. Displaced fractures also need to be treated surgically. In both cases, a screw fixes the fracture pieces in the correct position. It does not have to be removed, but can remain in the wrist forever. After the operation, the hand is immobilised with a plaster cast for about four weeks. It often takes two to three months for the bone to actually heal, although healing can be somewhat faster with surgical therapy. The healing process is monitored with X-rays to ensure that weight-bearing is not started too early.
Whether the treatment is conservative or surgical depends on the type and location of the fracture. In both cases, consistent immobilisation and continuous monitoring of the healing process are important.
The optimal aftercare after a scaphoid fracture
To restore full function while observing the healing process, an appropriately adapted therapy should be carried out. At the beginning, only light tensioning exercises are practised in the muscles, later light bending and stretching in the wrist is added, before strengthening exercises can be started after about 8 weeks. It is recommended to start hand therapy already a few days after the injury : The joints that are not enclosed by the plaster, i.e. the fingers and the second thumb joint - must be kept in motion so that they do not stiffen and subsequently cause problems.
How can the healing of the scaphoid be supported?
If the scaphoid fracture is recognised quickly, treated and monitored continuously during treatment, the prognosis for complete healing is positive. Here are a few tips on how you can support the healing process.
This way you can positively influence the healing of the scaphoid:
Address complaints and uncertainties regarding the therapy plan directly with your medical and therapeutic team .Reliablyfollow the home programme prepared by your therapist. Also move the shoulder and elbow of the injured hand to keep the lymph flowing and reduce swelling.Your motivation contributes decisively to the success of the therapy!
More information about AnyHand for patients? More info A fall on the hand during sport or in everyday life - a scaphoid fracture can happen quickly. It is important that it is recognised quickly and treated according to the type of fracture. Afterwards, optimal aftercare supports the healing process and prevents movement restrictions. This way you are well on the way to being able to use your hand in everyday life again as soon as possible.
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Frequently asked questions
Where is the navicular bone?
In German, both a foot bone and a carpal bone are called scaphoid bones. In the case of a scaphoid fracture, however, it is usually the scaphoid bone as part of the wrist that is meant. Together with seven other carpal bones, it forms the wrist, adjoins the radius of the forearm and is mainly responsible for transmitting force to the thumb.
How long is the plaster worn for a scaphoid fracture?
In conservative therapy, the cast is usually worn for 6-12 weeks. If an operation is necessary due to a complex fracture or other complications, a plaster cast is also prescribed afterwards for immobilisation. The wearing time can be somewhat shorter here, usually at least four weeks.
What is scaphoid pseudarthrosis?
If the bone pieces of the scaphoid do not grow together optimally, a so-called pseudarthrosis can develop. If healing is incomplete, movements between the fractured pieces are still possible, which can lead to wear and tear of the wrist over years. After years, complaints such as pain or restricted movement can be the result.
How long does a scaphoid fracture hurt?
Typical for a scaphoid fracture are pressure and movement pains in the wrist, which can last for several weeks. If the pain is severe, pain therapy can be helpful after medical clarification. However, it is also occasionally the case that pain subsides of its own accord soon after the accident. However, if a scaphoid fracture is suspected, the injury should be clarified by a doctor, as overlooking the fracture can lead to undesirable complications.
How long does it take to heal a scaphoid fracture?
The healing time depends on the complexity of the fracture and thus also on whether it is treated exclusively with a plaster cast and immobilisation or whether surgery is necessary. Due to the often weak blood supply to the bone, it can take several months for the scaphoid to heal. It is important that the injury is recognised quickly and that the follow-up care is controlled in order to avoid complications and a delay in the healing process.
This article deals with a health topic, but is not suitable for self-diagnosis or the selection of a suitable therapy. The individual case can only be reliably diagnosed by medical expertise.
Sources
Breier S, Diday-Nolle AP, Reiter Eigenheer A, Saur I. Hand Rehabilitation Volume 1 Fundamentals, Diseases. 3rd ed. Waldner-Nilsson B, editor. Heidelberg/Berlin: Springer-Verlag; 2013.
Schmidt H-M, Lanz U. Surgical Anatomy of the Hand. 1st ed. Stuttgart: Thieme; 1992.
Hirt B, Seyhan H, Wagner M, Zumhasch R. Anatomy and Biomechanics of the Hand. 3rd ed. Stuttgart, New York, Delhi, Rio: Thieme; 2015.
