Ask the Expert: Scaphoid Fractures?
Q: Last week, I was tripped playing soccer and landed hard on an outstretched right arm. My wrist was very sore after the fall but x-rays done after the game showed nothing was broken. Despite this, the physician’s assistant said I might have a scaphoid fracture and put me in a cast for 2 weeks. What is a scaphoid fracture and why was I casted? Frank
A: Dear Frank: Sorry about your injury. The scaphoid is a cashew shaped bone found on the thumb side of the wrist. It plays an important role in wrist movement and stability and it’s the most frequently fractured wrist bone. Scaphoids are most commonly injured by falling on an outstretched hand which can subject the bone to enough pressure to cause it to crack.
People with scaphoid fractures often present with pain, swelling and tenderness to touch over the thumb side of their wrist. They also have pain moving their wrist in certain directions and when they try to push off a surface using their injured wrist. Unfortunately, these same symptoms can occur with wrist sprains so x-rays are usually ordered. The challenge with diagnosing scaphoid fractures is that the fracture lines are often so small they simply cannot be seen on plain x-rays. Unfortunately, when no fracture is seen, people are often assumed to have a sprained wrist and are sent home with their wrist in a supportive wrap.
Proper management of someone with the above symptoms and a negative x-ray is to assume they have a scaphoid fracture and put them in a cast for 2 weeks. After 2 weeks, the patient returns for a second set of x-rays. If the new x-ray shows a scaphoid fracture, the person is placed in a cast for 6 or more weeks. If the x-ray is normal but the person is still tender to pressure over the thumb side of their wrist, they are also assumed to have a scaphoid fracture and casted for 6 or more weeks.
Why all the fuss over scaphoid fractures? People with symptoms consistent with a scaphoid fracture should never be taken lightly because these fractures are often associated with serious complications such as – delayed healing, non-healing, bone death, arthritis, decreased range of motion and reduced grip strength. Some of these complications are the result of damage to the scaphoid’s blood supply, some of them will require surgical repair and all of them can have a significant long-term negative impact on the quality of people’s lives.
The bottom line: Scaphoid fractures are serious injuries that require the sound level of medical care you received from your health care professional. Give this injury the time it needs to heal properly and while this is occurring stay active doing things that don’t bother your injured wrist. Exercise is medicine!
Dr. Darrell Menard OMM MD, Dip Sport Med
Dr. Menard is the Surgeon General’s specialist advisor in sports medicine and has worked extensively with athletes from multiple sports. As part of the Strengthening the Forces team he works on injury prevention and promoting active living.
Strengthening the Forces is CAF/DND’s healthy lifestyles promotion program providing expert information, skills and tools for promoting and improving CAF members’ health and well-being.
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