We all know that there are a surprising number of bones in our bodies, and when you start to look at the hand, it is even more astonishing to discover the amazing number of bones there as well. Just the area we know as the wrist contains a few groups of bones, including the carpal bones. They are composed of two rows of tiny bones, and these are linked by the “scaphoid” bone.
Because the scaphoid holds such a prominent position it ends up being the most commonly fractured carpal bone.
The Hidden Injury
The wrist is put under a lot of stress and strain in general, but one of the most common is intense pressure from a fall or a sharp blow with the hand. These types of incidents are what lead to a scaphoid fracture. For instance, someone is falling towards the ground and the natural instinct is to reach out with the hands to stop the impact. The pressure of the hands striking the ground can easily fracture the scaphoid.
The problem is that a fracture of this bone is not always obvious, and though there may be pain or bruising and tenderness at first, it may subside so quickly that the individual does not seek medical care. This is why many scaphoid fractures go undiagnosed for days, weeks, months or even years.
How is it diagnosed? Generally, it requires an x-ray to determine if the small bone has been broken, and even then it can be hard to detect. There is one key indicator, however, and that occurs in the area of the wrist known as the “snuffbox”, which is the noticeable hollow that appears at the outer base of the thumb at the wrist area. (AAFP.org, 2014) Should this area have tenderness, it is generally diagnosed as scaphoid fracture and the patient is then treated accordingly.
How Scaphoid Fractures Are Treated
There are two ways that the fractures of this bone occur – displaced and non-displaced. The non-displaced are the tricky fractures because they are not so obvious or even visible on an x-ray. The displaced are just as they sound – the bones are clearly displaced due to the fracture.
If diagnosis is not certain, the wrist is put into a splint and kept immobile until further x-rays or scans can detect the break. Treatment is ongoing immobilization using a cast over the entire forearm, hand, and thumb area. Generally requiring up to ten weeks (in some cases more) to heal, the treatment can be complicated by bone death.
Because a fracture to the scaphoid can interrupt the blood flow to the bone, healing may be a challenge. Surgery can be required to pin the bone together with a screw or bone graft, and even then healing is not guaranteed. The most common problems arising during or after treatment are non-union of the bones, death of the bone, and arthritis.
Though a tiny bone like the scaphoid may not seem all that vital or critical, it can cause many problems if broken and left untreated. Visiting a hand surgeon or expert immediately after any injury to the area is key to the best outcome.
AAFP.org. Diagnosis and Management of Scaphoid Fractures. 2004. http://www.aafp.org/afp/2004/0901/p879.html