Athletic Training Blog Series #17
Scaphoid Fracture
The Scaphoid bone is a navicular bone in the wrist. It is one of the carpal bones that articulate with the Radius and Ulna. It can be located by holding your thumb in a “hitchhikers” position. The area or divot created by the tendons is where this bone is located. This area is also called the anatomical snuff box. This is the area where pain and tenderness occurs if there is a fracture.
These fractures typically occur from a fall on an outstretched hand (FOOSH). There are 2 kinds of fractures in this bone. A non-displaced fracture means that the bones line up properly. A displaced fracture means that the bones are not aligned correctly. There may be gaps or multiple pieces of bone fragments. Unlike other injuries there are not any true predispositions for this injury. It can happen in car accidents, sports, or just a fall. Wearing wrist guards in sports such as skateboarding or snowboarding may help prevent it.
Over the years, I have dealt with a few more of these injuries (including one year where we had 4 different athletes have fractures). As a result, I have learned a fair amount of tricks to help catch it. If this injury is not caught early on, the bone may not heal correctly even with surgical intervention due to the low level of blood flow to the area. Many Scaphoid fractures will first present very similarly to a wrist sprain. If there is pain in the “snuffbox” area, I will typically refer to a hand specialist. Sometimes this fracture does not show up on X-Rays until almost 6 weeks after the injury, as the bone fragments begin to die off, thus a hand specialist will be able to order an MRI or CT scan to get the correct diagnosis quickly, and start the course of treatment.
Treatments vary depending on the fracture location and severity. If the fracture is nondisplaced and closer to the thumb, it is possible that you will only be casted or splinted including your thumb. There will be frequent x-rays to make sure that it is healing correctly. If the fracture is displaced or closer to the wrist, you may end up needing surgery. During the surgery, they will fixate the bone back together with a screw or wires. In the most severe cases, they will also do a bone graft to promote healing. Unfortunately these fractures heal very slowly-sometimes up to 6 months. Once you are out of the cast-you may need PT or OT to help regain strength and range of motion. Depending on your sport of choice you may have a splint or brace to wear to give you extra protection against repeat injury.
