Hand

Scaphoid bone fracture

Złamanie kości lódeczkowatejA scaphoid bone is one out of eight wrist bones and the largest bone of the proximal row. Scaphoid bone fracture is the most frequent wrist fracture and accounts for about 80% of all fractures in this area. The injury is most often sustained when falling on the bent wrist, the so-called support.

Diagnosis
When taking a complete medical history, a patient usually reports that he/she fell on the straight upper limb with the wrist in hyperextension.

Early symptom of the scaphoid bone fracture is pain in the wrist from the back side.

The pain is accompanied by the swelling located in the radial side of the wrist, and limited joint mobility.

The diagnosis is often based on the identification of distinctive symptoms, such as pain in the anatomical snuffbox as well as pain in the apprehension of I and II finger.

It is necessary to perform precise X-ray tests in various projections and then carry out a precise evaluation. Despite a frequent occurrence of this injury, it is relatively difficult to diagnose.

Sometimes the magnetic resonance turns out to be of assistance as it allows a precise evaluation of the fracture and life of bone fragments.

Treatment
Scaphoid bone fracture without dislocation is subject to conservative treatment and the injury is immobilized in the cast for 6-12 weeks. As far as performance athletes are concerned, the stable fractures may be subject to surgical treatment. After a plaster cast has been put, it is possible to recover as soon as after 2 weeks but the immobilizing orthesis must still be used until the adhesion has been confirmed in the X-ray image. As for unstable fractures with dislocation, it is necessary to set and combine it in the surgery. Treating such cases in a conservative way may result in improper adhesion.

Surgical treatment of scaphoid bone fractures is recommended for the following:

  • Fracture with dislocation above 1 mm;
  • Comminuted fractures;
  • Proximal pole fracture;
  • Late diagnosis and treatment;
  • Fragments angular dislocation.


Prognosis
In spite of a suitable diagnosis and early treatment, this injury entails substantial consequences. Most distal pole fractures heal after immobilizing in the plaster cast. Non-dislocated fracture of waist or dislocation up to 1mm, are considered stable and may be subject to conservative treatment. Fractures in the proximity of the bone proximal pole may lead to permanent lack of adhesion (false joint/pseudarthrosis) exceeding 50%. Taking physical activities after unstable fracture combination is possible but depends on the quality of combination during the surgery. A full recovery occurs when X-ray or MRI tests show full adhesion of fragments. Once the scaphoid bone has healed, it is usually necessary to undergo an intensive rehabilitation which allows regaining the range of movements in the wrist.

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