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SCAPHOID FRACTURE

A scaphoid fracture is a break to the scaphoid bone, which is one of the eight carpal bones in the wrist. The scaphoid is the most commonly broken carpal bone, responsible for 80–90 per cent of all carpal fractures. The scaphoid bone is the cornerstone of the wrist, and it is extremely important that a fracture is allowed to heal properly with the right treatment for the right amount of time.

What are the symptoms of a scaphoid fracture?

Scaphoid fractures are easy to miss at the time of injury because the fracture doesn’t always show up on the first X-ray.

The symptoms of a scaphoid fracture are:

  • wrist pain on the thumb side
  • pain when you pinch your thumb to your index finger with the palm facing downwards
  • swelling around the painful area (including loss of the ‘snuff box’ (triangular deepening) divot normally seen when you lift up your thumb)
  • weak wrist and reduced grip and pinch strength
  • reduced and painful movement of the wrist.
 

What causes scaphoid fractures?

Scaphoid fractures are usually the result of a fall on an outstretched hand, particularly if you land on the base of the thumb. Often the wrist is forced too far backwards, although a forceful bend forward can also fracture the scaphoid. Sometimes, the fall involves speed or height.

Scaphoid fractures are divided into three categories and each requires different treatment to make sure the bone heals completely.

Each part of the bone has a different amount of blood supply, which can influence how the fracture heals. A proximal pole fracture has poor blood supply, making the healing process more difficult. This increases the chance of the fracture not healing.

The right treatment for a scaphoid fracture varies from a cast (worn for 6–12 weeks) to the surgical fixation of the bone plus a cast.

 

How do I know if I have a scaphoid fracture?

If you have the symptoms described above after sustaining a fall, it’s important to see your GP or physiotherapist for an X-ray. You may need a follow-up X-ray because these fractures sometimes do not show up on initial X-rays. After 10 days, the fracture is more likely to show up. Your GP or physiotherapist may also suggest an MRI. This is more expensive, but shows the scaphoid bone much more clearly.

After the initial injury and after the swelling settles down, you tend to feel the symptoms of a scaphoid fracture around the bone. You can suspect you have a scaphoid fracture if you have ongoing pain around the area where your thumb meets your wrist after a heavy fall, even if the X-ray at the time was clear. A 50 per cent decrease in grip strength compared to your other wrist also suggests a fracture.

 

How can physiotherapy help with scaphoid fractures?

Cast or splint

You will have a plaster cast or thermoplastic splint fitted. The elbow is usually left free, and the thumb is often included, although there is increasing evidence that it is safe to leave the thumb out of the cast. Sometimes a temporary plaster ‘backslab’ will be applied for the first week, to be replaced with a waterproof cast once the initial swelling has settled down.

Rehabilitation

Your physiotherapist or hand therapist will be involved in rehabilitation after your cast is removed or after you have an operation to fix the bone (whichever is required in your case).

Exercise

You will be given a set of graduated exercises designed to regain your full movement and wrist strength.

Mobilisation and soft tissue techniques

You may have reduced movement in your wrist and thumb, requiring correction through mobilisation and soft tissue techniques.

Return-to-sport and work

The timing of your return to sport or work will depend upon your progress and the physical demands that will be placed upon your wrist.

 

How effective is physiotherapy for scaphoid fractures?

People with scaphoid fractures usually require the help of a physiotherapist to overcome the stiffness that develops in their thumb and wrist joints, and the weakness in their hand that comes from a period of immobilisation in the cast or splint. Your physiotherapist can guide you on appropriate exercises to get your joints moving and improve your strength over time, so you can gradually return to your usual activities.

There is currently a lack of studies on the effectiveness of physiotherapy or hand therapy specifically for scaphoid fractures. However, rehabilitation is widely recognised as an important part of each person’s recovery from a scaphoid fracture.

 

What can I do at home?

  • Keeping your arm elevated in the early days after a fracture is helpful to reduce swelling
  • It is also important to make sure your shoulder, elbow and fingers don’t get stiff, so keep them moving when the cast is on. You should have full finger movement in your cast and be able to make a full fist as well as being able to move at least the tip of your thumb
  • You will be given a home exercise program to complete by your physiotherapist
  • It is usually safe to use the injured hand for light activities, with the splint or cast on and within the limits of pain. Talk to your GP or physiotherapist about which activities are safe for you to do.
 

How long until I feel better?

Scaphoid fractures take 6–12 weeks to heal. It is fairly common for people to still experience some stiffness or mild discomfort up to 12 months after their fracture. 

 

Source: Choose.physio