A fracture of a carpal bone is called a scaphoid fracture. The scaphoid is the most vulnerable bone in the carpal region and is also known as the os scaphoideum. A scaphoid fracture can also occur in the foot in rare cases, as there is also a scaphoid bone in the tarsal bones there.
What is a scaphoid fracture?
Schematic diagram showing the anatomy of the hand in scaphoid fracture. Click to enlarge. A scaphoid fracture is a fracture in the region of the carpal bones. The scaphoid is located between the radius and the first metacarpal bone and connects the wrist to the metacarpal. It is on the thumb side and is located in the first carpal row. A scaphoid fracture is most common among the carpal bones. A scaphoid fracture is relatively difficult to diagnose. Furthermore, so-called pseudoarthrosis, a mishealing of the bone, often occurs. Both the wrist and the ankle have a scaphoid bone in the root bones. Because of this, a scaphoid fracture can also mean a fracture of the tarsal bones. However, this type of fracture occurs extremely rarely. The healing of a scaphoid fracture usually takes up to 12 or more weeks.
Causes
The most common cause of a scaphoid fracture is an accident. The fracture usually occurs as a result of a fall that you try to break with your hands. One usually falls on the outstretched hand, which is bent backward on impact. As a result, the scaphoid bone is pinched between the radius and the other carpal bones. When great force is applied, the scaphoid fractures. A scaphoid fracture also often occurs as part of a car accident. During the collision, the driver rests his hands on the steering wheel. In the process, the victim often sustains a scaphoid fracture.
Symptoms, complaints and signs
If a scaphoid fracture occurs, severe pain immediately sets in around the wrist. The discomfort occurs mainly near the thumb and increases when the hand and fingers are moved. The fracture is associated with swelling or bruising, and skin damage and bleeding occur with external injuries. The scaphoid fracture symptoms mentioned above are usually non-specific and may have other causes. A definite sign is the severe pain that occurs when pressure is applied to the wrist. If the joint is touched at the site of the fracture, an acute stabbing sensation occurs, which may radiate into the hand and forearm. If treatment is not received, the pain can become so severe that nausea and circulatory problems can occur. Restricted movement is also a clear indication of a fracture. The hand can normally no longer be moved, or only to a limited extent, resulting in a protective posture. Above all, the grip movement of the hand is considerably restricted. In some cases, sensory disturbances and paralysis occur. If nerves have been injured, this can result in complete paralysis of the affected hand.
Diagnosis and course
Scaphoid fractures are diagnosed by an orthopedic surgeon. However, diagnosis can often prove difficult. To begin, the injured hand is examined for external injuries. This is followed by an examination of the mobility. This includes palpation of the hand to determine whether movement or pressure is causing pain. In addition, it is determined whether there is a sensitivity disorder. After the visual and palpation examination, X-rays are taken in four planes, although these do not always reliably show a scaphoid fracture. Because of this, a computer tomography is usually taken as well. This also provides information about which treatment method (conservative or surgical) is most suitable. The course of a scaphoid fracture depends on several factors. With a stable fracture and adequate treatment, the scaphoid fracture usually heals without consequences. The healing phase can take up to 12 weeks or more. Often complications occur – especially with scaphoid fractures that are not discovered or discovered too late – in the form of pseudoarthrosis. In this case, the bone heals incorrectly or only insufficiently together. Due to circulatory disorders, healing may also be delayed. A scaphoid fracture can result in a permanent restriction of movement as well as chronic pain.
Complications
In general, scaphoid fractures can occur in either the hand or the foot.In both cases, this results in restrictions and pain in the patient’s everyday life, so that the quality of life is significantly reduced by this symptom. Most patients also suffer from swelling in the affected areas. If the scaphoid fracture occurs in the hand, the usual grasping and taking is no longer possible for the patient. The sensitivity of the hand may also be disturbed by the fracture, resulting in paralysis or tingling. Complications can occur if the scaphoid fracture is not treated. This can result in irreversible movement restrictions. Diagnosis of the scaphoid fracture is relatively simple and can be performed quickly. This also allows treatment to be initiated at an early stage. No particular complications occur during the treatment itself. If necessary, a disturbance of the blood circulation can also occur at the affected site. This disorder must also be treated. The patient’s life expectancy is not changed by this fracture. With the help of a cast, the discomfort disappears after a few weeks and the patient can usually use the hand or foot again.
When should you see a doctor?
A doctor should be consulted after a serious accident. If a fall or accident results in an injury to the scaphoid, the doctor should always be consulted. Warning signs such as swelling or externally visible bruising should be clarified in any case. Bleeding or even an open fracture also require immediate diagnosis and treatment by a specialist. This is especially true if the injury restricts movement or causes other complications. If there are signs of paralysis or sensory disturbances in the affected part of the body, a doctor must be consulted. A scaphoid fracture usually heals quickly and without complications if treated early. However, consultation with the physician should be maintained during recovery. If pain occurs during healing or there is a feeling that the bone is not growing together properly, a doctor must be consulted. The proper person to contact is the family physician or an internist. Seriously injured patients must be treated in a hospital.
Treatment and therapy
In the treatment of a scaphoid fracture, the immediate recommended measures are elevation of the hand, cooling with cool packs, and resting the hand. A CT scan can be used to see how and where the scaphoid is broken. Based on this, a decision is then made as to whether conservative treatment will be given or whether surgical intervention is necessary. In the case of a stable scaphoid fracture, a plaster or plastic bandage is applied after the swelling has subsided and must be worn for up to 12 weeks. Usually, the hand, thumb and forearm are plastered. If the bone parts are displaced in a scaphoid fracture, surgery is usually required. In this case, the scaphoid bone is fixed with the help of several screws. During the healing phase, X-rays must be taken regularly to monitor the healing process. These serve to monitor the healing process. Furthermore, it is checked whether there is a circulatory disorder. The treatment of a scaphoid fracture can take a very long time and, under unfavorable circumstances, can result in secondary damage. After removal of the plaster cast, physiotherapeutic measures are recommended for a scaphoid fracture. If a scaphoid fracture is present in the tarsal region, the same treatment methods are usually taken.
Outlook and prognosis
Provided that the scaphoid fracture is located at the foot bone, absolute rest must be observed throughout the healing process. In the case of a scaphoid fracture on the hand with immobilization by a cast, light activities can be resumed after about one month. Since muscles atrophy and tendons shorten during prolonged immobilization, regular physiotherapy must be started after clearance by the doctor. In order to achieve visible results quickly, this must also be supplemented at home with gentle exercises from the fields of physiotherapy and occupational therapy. However, the therapist’s instructions must always be observed here, as excessive strain could lead to a new fracture. As a rough guideline, intensive sporting activity should only be undertaken after about six months. Regular X-ray examinations provide information about the load-bearing capacity.If the fracture is repaired without plaster immobilization, but by means of a small outpatient procedure involving the insertion of a cannulated screw, the fracture can heal more quickly, thus enabling the patient to bear weight more quickly. In order to alleviate the sometimes very severe pain, affected persons can also resort to natural remedies in addition to the prescribed prescription drugs. Some preparations are both internally as a tea, drops or tablet applicable, but also as a cream to apply directly to the painful area.
Prevention
There are no preventive measures to prevent a scaphoid fracture. You can only take general precautions such as being mindful in traffic, running only on level ground, avoiding high-risk sports where falls are inevitable.
Aftercare
Aftercare for a scaphoid fracture consists of several steps. First, the wrist is immobilized. Depending on the type of fracture, immobilization can last from one to two days to six weeks. In the case of fractures that are more difficult to heal, immobilization may last even longer. This is assessed and decided on a case-by-case basis by the operating physician. The stitches on the scar are removed approximately 12 to 14 days after surgery. There are typically three to seven sutures that need to be removed. Immobilization is by means of a forearm plaster splint. Except for the thumb end joint, the plaster splint immobilizes the wrist and the rest of the thumb joints. The plaster splint is also used at the beginning of non-invasive treatment. To inspect the wound, the cast may be changed two to three times a week for the first few weeks. Once the stitches have been removed, the wrist is immobilized with a removable wrist splint. As soon as the splint is removed, full weight-bearing should nevertheless be refrained from for the time being. The operated hand must be continuously reaccustomed to normal weight-bearing. The attending physician can tell most accurately from X-rays when full weight-bearing is possible again. Sports activities should be refrained from for another three to four months.
Here’s what you can do yourself
After a scaphoid fracture, the affected person must initially take it easy. The affected person should take a sick leave for at least five to six weeks. Office activities can usually be resumed after three to four weeks. Since the muscles atrophy after the long period of immobilization and the tendons are usually shortened, consistent physiotherapy is indicated afterwards. Outpatient mobilization measures such as physiotherapy or occupational therapy are also necessary and can be supplemented with gentle exercises at home. The physician will inform the patient which exercise methods are useful and promote healing. Strenuous physical activities should be avoided during the first few weeks, otherwise a new fracture can develop relatively quickly and recovery is delayed. In addition to prescribed medications, the patient can also try various remedies from nature. The pain-relieving devil’s claw, for example, can be taken as a tea or applied as an ointment. After the cast is removed, ointments and creams may be applied to the injury after consultation with the doctor. If the scaphoid fracture has not healed after a few weeks, the doctor must be informed.
