Scaphoid Fracture

Caused by a fall on the outstretched hand, a scaphoid fracture often goes unreported and unrecognized for many months after it has occurred. Wrist injuries are common and usually consist of minor sprains, strains and contusions. A "sprained" wrist should never be taken lightly and should always be considered a fracture until proven otherwise.

Anatomical Details

  • The scaphoid bone is located on the thumb side of the wrist. It can be palpated by compressing between the radius and second row of carpal bones.
  • It is important to remember that the wrist can move in any one of six different ways (flexion, extension, adduction, abduction, radial and ulnar deviation).
  • The long-term consequences of an unhealed scaphoid fracture is a disabling, painful arthritis of the wrist. As many as 40 percent of scaphoid fractures do not heal properly and require prolonged immobilization and possibly surgery. This is due to the blood supply being cut off from the fracture, leading to degeneration and necrosis of the bone.

Signs and Symptoms

  • Usually appears to be a simple sprained wrist, with pain, stiffness, tenderness, or sometimes just slight soreness.
  • Pain focused on the thumb side of the wrist (in the anatomical "snuff box"). Extend the thumb outwards and upwards and palpate the triangular gap created at the base of the thumb on the lateral side for pain.
  • Pain aggravated by strong gripping.

On-Site Management

P.R.I.C.E. PROTECT the area from further injury (i.e. splint). Very important to REST the area until full healing has occured to prevent a chronic injury that can compromise blood flow. ICE the area to reduce inflammation. COMPRESS the area to move inflammation away. ELEVATE the area to increase circulation towards the heart. 

Referral and X-ray. Every injured wrist should be X-rayed within a day or two of the injury. Initial X-rays may not reveal the fracture, and a second X-ray should be taken fourteen days after the first one. If there is a fracture, it should be clearly visible in the second X-ray. If there is any doubt, a bone scan will confirm the diagnosis.

Rehabilitation. After approval from a physician, see a physiotherapist for exercises to increase range of motion and strength of the wrist and hand.

Return to Activity
Only after a physician confirms solid healing of the fracture. Although some athletes opt to continue to play with a cast, this is risky and not recommended.

Prevention

  • Warn athletes about the danger of falling on an outstretched hand. Advise them to use wrist protection if appropriate (for in-line skating for example).

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