Scaphoid Fractures

What are Scaphoid Fractures?

The scaphoid is the most commonly injured of the carpal bones. We have eight total carpal bones set in two rows. The scaphoid ‘bridges’ both rows of bones, which is why it is commonly fractured in a fall.

Symptoms & Causes

First, the scaphoid bone can suffer a non-displaced fracture that does not show up on routine x-rays. The bone itself is in the shape of a twisted peanut, making visualization difficult. This may lull patients into a false sense of security of thinking the bone isn’t broken just because initial x-rays were read as ‘normal’. However, a non-displaced fracture can easily transition into a displaced fracture if not detected and immobilized. Second, the blood supply to the scaphoid comes from the distal or hand side–this means the blood supply comes through the bone, not into the bone. Therefore, the blood supply is disrupted if the bone is broken, which can cause the bone to heal properly and, in some cases, even die.

Affected Populations

Most scaphoid fractures occur in males, with an average age of 25. Up to 61% of scaphoid fractures occur during a sporting event. Furthermore, because of the nature of those typically injured, they can often present weeks or months following the injury with an unhealed fracture.

Treatment

Non-displaced scaphoid fractures can be treated in a cast. A non-displaced fracture will have less than 1mm of a ‘step-off’ or gap at the fracture site and is usually found in younger children. Any complete fracture will need operative fixation. In minimally displaced fractures, this is done with a screw, but sometimes bone grafting is needed because the fracture is comminuted or in multiple pieces.

Scaphoid Fracture