Scaphoid Injuries

Scaphoid Injuries
Posted on 01/13/2021
Scaphoid Injuries

Chris Mathewson, MSS, LAT, ATC, CSCS
Head Athletic Trainer, Ponderosa High School


Within Douglas County School District (DCSD) injuries to the hand/wrist comprise around 8% of all high school athletic injuries suffered during the school year. One of the most common injuries to the wrist/hand is a fracture of the scaphoid bone. I am quite sure that I have had at least one athlete suffer a scaphoid fracture every year I have been at Ponderosa, all 27 of them.

The scaphoid bone (aka navicular) is one of the carpal bones on the thumb side of the wrist, just above the radius (Image 1). The word “scaphoid” comes from the Greek term for “boat” because of the long, curved shape of the bone. The scaphoid can be identified by placing your thumb into the “hitch-hikers” position. It is located at the base of the thumb in between the two tendons, an area sometimes called the “anatomical snuff box” (Image 2).

Image 1Image 2

When injured, athletes will usually present with mild pain and minimal swelling over the scaphoid. More often than not the pain will increase with movement of the thumb or wrist, or especially when they try to pinch something. The most common mechanism of injury (MOI) for scaphoid fractures is to fall on an out-stretched hand (FOOSH).

One problem I have found with assessing scaphoid fractures is that rarely is there any type of deformity. Only once have I seen a scaphoid fracture that presented with deformity. Most of the time the athlete will describe a dull pain. Correct and immediate diagnosis of a scaphoid fracture is very important. The healing process can be slow due to the poor blood supply to the area.

A scaphoid fracture may not show up on an x-ray immediately. Magnetic resonance imaging (MRI) scans can sometimes show a fracture of the scaphoid before it can be seen on an x-ray. Computed tomography (CT) scan can be helpful in determining whether the bones are displaced or not.
Image 3
A scaphoid fracture is typically described by its location on the bone itself. The most common scaphoid fracture occurs in the mid mortion of the bone, referred to as the “waist”. Depending on how much the pieces of the bone have moved from the healthy position, the injury is further described as follows:
  • Non-Displaced Fracture:  The bone is fractured but still lines up in place correctly. (Image 3)

  • Displaced Fracture: The bone fragments have moved out of their normal position causing gaps between the pieces of bone or overlapping fragments
In some cases the blood supply to the area can be disrupted resulting in avascular necrosis. This occurs when the bone is not supplied with nutrients for a period of time, causing the cells to die. This complication is most common with displaced fractures and compromises the healing process significantly. Evaluation and treatment by a qualified healthcare provider will help reduce such complications and provide the best chance of a good recovery.

After imaging has determined the presence of a fracture, the plan of care your physician creates will be based on three factors:
  • Fracture location on the bone

  • Displaced or non-displaced fracture

  • How long ago your injury occurred

Image 4Fractures that occur closer to the thumb will typically heal in four to six weeks. Usually the physician will place the wrist and forearm in a thumb spica cast (Image 4). In most of these cases athletes will be allowed to continue participating in his/her sport with foam rubber padding taped over the cast.

Scaphoid fractures that occur towards the wrist, or if the pieces of bone are displaced will usually require surgery. The surgeon will realign and stabilize the bone fragments, which helps the bone heal properly.. In the most severe cases a bone graft (a piece of bone taken from another place in the body) is placed around the fractured bone.

In my experience athletes, parents, and coaches only consider fractures “serious” if they see something out of place or at an extreme angle. People often assume they only have a sprained wrist, since the symptoms are similar. As such they are usually slow to seek evaluation and treatment. It is this delay that can cause significant long lasting problems.

References:
  1. https://www.hss.edu/condition-list_scaphoid-injuries-wrist-pain.asp

  2. https://emedicine.medscape.com/article/328658-overview

  3. https://orthoinfo.aaos.org/en/diseases--conditions/scaphoid-fracture-of-the-wrist/

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