Have you ever fallen and hit your hand on the ground, causing a severe injury to your wrist? Or maybe you twisted your hand the wrong way while playing, and then the area swelled up and you couldn't move it? Sometimes we think of these things as "just a sprain," but they can be something more serious. That's what can happen when something like this happens, called a scaphoid fracture. Let's talk about this in more detail today, okay?
What is a Scaphoid Fracture?
Simply put, a scaphoid fracture is a break in the bone in your wrist. The scaphoid bone is located at the base of your big toe, near your wrist. Your wrist is made up of several small bones called carpal bones. The scaphoid is one of those carpal bones.
This often happens when we fall and reach out to catch our hands. Imagine, you suddenly slip and fall, and you immediately put your hands on the ground to save yourself, right? That's when this bone is most likely to be damaged. Apart from that, it can also happen from car accidents, hard impacts while playing sports, etc. Sometimes surgery is required to properly fix this bone. Most people take about three months to fully recover from this condition.
Parts of the scaphoid bone and where fractures occur
This scaphoid bone also has three parts. Any of these parts can break.
- Distal pole: This is the end of the scaphoid bone that is toward your hand and fingers, that is, away from the forearm.
- Waist of the scaphoid: This is the middle of the scaphoid bone. Most of the time, that is, more than 70% of scaphoid fractures occur in this middle part.
- Proximal pole: This is the end of the scaphoid bone that is toward your forehead, inside your body.
These words may sound strange to you. But doctors use them to help them understand exactly how your wrist is broken, where your scaphoid bone is broken, and how the bone is currently positioned inside your body. However, no matter what you call it, the most important thing is to see a doctor as soon as possible and get it checked out.
How common is this? Who gets it most often?
Scaphoid fractures are the most common type of fracture of the carpal bones of the wrist, accounting for about 15% of all wrist injuries.
In fact, anyone can break a bone, and anyone can break a scaphoid bone. This is because it is most often caused by falls or other accidents. However, it is more common in young people under the age of 30 and in adolescents . If you are prone to falling, you are also at higher risk. Also, people with bone thinning diseases such as osteoporosis are more likely to break bones more easily than others, so the risk of a scaphoid bone fracture is also higher.
What are the symptoms?
If you have a scaphoid fracture, you may experience symptoms like:
- Pain: Especially at the base of the big toe, right at the wrist.
- Swelling: The affected area of the hand may swell.
- Tenderness: The area mentioned above hurts when touched or pressed.
- Inability to move the wrist: Difficulty turning or lifting the hand.
- Bruising or discoloration: It may appear blue or purple.
- An unusual lump or deformity: The wrist may feel or look like an unusual lump.
Displaced and non-displaced fractures
These are two other words that the doctor will use to describe your fracture. A ``Displaced fracture'' means that after the bone breaks, the two broken pieces have moved a lot, leaving a large gap between them. In a ``Non-displaced fracture'', the bone is still broken, but the two pieces haven't moved much, and are still close to where they were. A ``Displaced fracture'' often requires surgery to fix.
Why is this happening?
Any forceful impact to the wrist can cause a fracture of the scaphoid bone. The main causes are:
- Falls: Reached out with both arms outstretched and reached for the ground.
- Sports accidents: Like when playing cricket or football.
- Vehicle accidents.
How do doctors detect this?
A doctor will diagnose whether you have a scaphoid fracture by examining you and doing several imaging tests.
What tests are being done?
After you are examined, you may have one or more of the following imaging tests:
- X-rays: An X-ray can show if there is a fracture in the scaphoid or other bone and how much damage is done.
- Magnetic resonance imaging (MRI): Sometimes your doctor will order an MRI scan. This can help to fully assess the damage to the bones and the surrounding muscles and tissues.
- CT scan: If you need to have surgery, your doctor will need a very clear picture of the damage to your bones. A CT scan can show the bones and surrounding tissue in more detail than an X-ray.
Occult scaphoid fractures
Sometimes scaphoid fractures don't show up on an X-ray, and sometimes they don't show up at all. This is called an occult scaphoid fracture. If this happens, your doctor may order an MRI or CT scan. Your doctor will tell you what additional tests you may need.
Important: Tell your doctor exactly where you are hurting and what hurts when you press on it. If your pain is located in the scaphoid bone, and it doesn't go away after a day or two, you may have a hidden fracture. These hidden fractures don't require any special treatment, and they don't pose any special risks.
What are the treatments?
The treatment for your scaphoid fracture depends on how serious it is. Your broken bone needs to be put back together and healed. Depending on how damaged it is and how it was broken, your doctor may use one or more of these treatments.
Immobilization of the hand/wrist
If your fracture is not too big, meaning the scaphoid bone has not moved too far from where it was (`non-displaced`), you may only need to wear a splint or a plaster of Paris cast. A splint usually lasts for about three to five weeks. A cast lasts a little longer, usually six to eight weeks. In both cases, you will need to have another X-ray to make sure your bone is healing properly.
Bone reduction without surgery (Closed reduction)
For more serious fractures, a procedure called a closed reduction is performed to realign the scaphoid bone. This is not surgery. The doctor will press and pull on the outside of your body to realign the broken bone inside. While doing this, he or she will do one of the following to help you feel less pain:
- Local anesthetic is injected to numb the area around the broken bone.
- Sedatives are given to relax the entire body.
- Your entire body will be anesthetized and you will be put to sleep (`General anesthesia`).
After performing this ``(Closed reduction)``, the doctor will put a splint or plaster on you.
Scaphoid fracture surgery
Most serious fractures require surgery. The surgeon will realign your scaphoid bone and fix it in place, so it can come back together and heal. Most often, they will do something called ``Internal fixation.'' This means that the surgeon will insert metal pieces inside your bone to hold it in place until it heals. These ``Internal fixation'' methods are:
- Plates and screws: Metal plates and screws that are inserted into the bone to hold the bone fragments together.
- Pins and wires: Pins and wires are used to hold smaller bone fragments together than other fixation devices. They are usually used in conjunction with plates or other devices such as rods.
Some people have these metal pieces in their bodies forever. Some people have to have surgery again to remove them.
Bone grafting
If your scaphoid fracture is very ``displaced,'' meaning the pieces are far apart, or if your bone is not healing properly, you may need to have a procedure called ``bone grafting.'' The surgeon will insert additional bone tissue to help your broken bone come back together. Then, they will usually perform ``internal fixation,'' holding the pieces together until the bone heals. There are several places where bone can be taken for these bone grafts:
- From somewhere else on your own body – most often on the top of your hip bone.
- From someone else (external donor).
- An artificially made piece.
Scaphoid fracture surgeries are often performed as outpatient procedures.
After your surgery, your wrist will need to be immobilized. You may need to wear a splint or cast before you can use your hand again as you did before it was broken.
What medications are used for scaphoid fractures?
Painkillers called ``NSAIDs'', such as aspirin or ibuprofen, can cause bleeding and other complications after surgery. Therefore, your surgeon will talk to you about medications you can take to reduce pain after surgery.
Possible side effects of NSAIDs:
- Bleeding.
- Stomach ulcers.
- Stomach pain.
- Intestinal complications.
Will a scaphoid fracture heal on its own?
Never ignore symptoms like pain, swelling, or tenderness. Even if your symptoms are not severe, you still need treatment. If you don't get treatment for a scaphoid fracture, you could end up with serious complications later, such as:
- Acute compartment syndrome (ACS): Pressure inside the muscle increases, blood flow to the tissues is cut off, and permanent muscle and nerve damage can occur.
- `(Malunion)`: When your broken bones don't fit together properly when they heal.
- Nonunion: Your bones are not completely or partially joined back together.
- `(Avascular necrosis (osteonecrosis))`: This is a painful bone disease that gets worse over time. It can affect your ability to move. It happens when blood flow to a bone is cut off.
- Arthritis of the hand: Conditions called ``Nonunion'' and ``Avascular necrosis'' can cause arthritis in the hand and wrist. Arthritis of the hand can cause pain, swelling, stiffness, and deformity.
How quickly will I feel better after treatment?
It may take several weeks for your symptoms to subside. Depending on the type of surgery you had to repair your scaphoid fracture, you may be able to move your arm again within a few weeks.
However, if you have unbearable pain that doesn't subside, see a doctor immediately.
How can this risk be reduced?
Follow these general safety tips to reduce the risk of injury:
- Always wear your seat belt when riding in a vehicle.
- Wear appropriate safety equipment for every activity and sport.
- Keep your home and workplace tidy by removing items that could cause you or someone else to slip and fall.
- When picking up anything from above, always use the right tools or equipment. Never climb on chairs or tables.
- Follow a diet and exercise plan that helps maintain your bone health.
- If you are over 50 years old, or if someone in your family has osteoporosis, talk to your doctor about getting a bone density test.
- If you use a cane or walker to walk, always use it, and be careful on uneven surfaces.
Can I prevent a scaphoid fracture?
Scaphoid fractures are most often caused by falls or other accidents, so there is not much that can be done to prevent them, other than being careful when walking (using a cane/walker if you have one) and being careful on uneven surfaces.
What can I expect if I have a scaphoid fracture?
If you have a scaphoid fracture, you can expect a full recovery.
You will need physical therapy to regain strength and range of motion in your wrist.
How long does it take for a scaphoid fracture to heal?
The time it takes for you to recover will depend on the severity of your fracture and the treatment you need. Most people take about three months to heal from a scaphoid fracture.
There are many other factors that can affect how long it takes for your body to heal. Talk to your doctor or surgeon about a time frame that is right for your situation.
Will I be unable to go to work or school?
If you can still do your job or schoolwork without moving your wrist, you won't be unable to go to work or school.
While you are healing, talk to your surgeon or doctor before you resume physical activity.
Outlook for a scaphoid fracture
The outlook for scaphoid fractures is good. Even if you have surgery, you should make a full recovery, as your fracture is unlikely to have long-term effects.
When do you need to go to the hospital urgently?
If you think you have a scaphoid fracture – or any other bone fracture – you should see a doctor as soon as possible. Go to the emergency room immediately if you have any of these symptoms:
- Unbearable severe pain.
- If you can't move a part of your body that you can normally move.
- If a part of your body looks different than usual, if it seems to have jumped out of place.
- If your bone is visible through your skin.
- Swelling.
- If new bruises appear along with these other symptoms.
If you have had a major accident (trauma), go to the emergency room immediately.
What questions should you ask the doctor?
- Do I have a scaphoid fracture, or another type of fracture?
- What part of my scaphoid bone is broken?
- Will I need surgery?
- How long will it take to heal?
- When can I start physical activity again?
Breaking a bone is always scary, especially if it happens suddenly, like when you slip and fall. Scaphoid fractures respond well to treatment, and there are many options to help your bones and body heal properly. Talk to your doctor about ways to keep your bones strong and healthy, and get regular bone density tests if you're over 50 or if someone in your family has osteoporosis.
Finally, things to remember
So, you see, even if you have a little trouble with your wrist, it's not a good idea to just ignore it. A scaphoid fracture is something that can be completely cured if treated properly.
The most important thing is to see a doctor as soon as possible if you have symptoms. That way, they can find out exactly what's going on and start the necessary treatment.
Remember, it is very important to take care of your bone health. A balanced diet, proper exercise, and taking precautions to protect yourself from accidents can help prevent these conditions to some extent. If you have any questions, don't hesitate to ask your doctor. Then you can be sure.
` Scaphoid fracture, wrist fracture, hand pain, bone fracture, X-ray, MRI, bone surgery
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