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Where is the Scaphoid Bone Located?
The wrist is composed of two forearm bones (the radius and ulna) and eight small bones arranged in two rows. The scaphoid is the largest bone in the proximal carpal row and is located on the radial side of the wrist. Its name derives from its boat-like shape. Over 80% of the scaphoid is covered with articular cartilage.
What is the Function of the Scaphoid Bone?
The scaphoid bone, together with other carpal bones, provides structural support for the hand and wrist. It plays an essential role in wrist joint functionality. It contributes to wrist movement alongside the lunate bone and the distal surfaces of the radius and ulna. The scaphoid is particularly significant because it connects the two rows of carpal bones, helping to stabilize the wrist.
Causes of Scaphoid Fractures
Among all carpal bones, the scaphoid is the most frequently fractured. This injury commonly occurs in men aged 20–40 and less frequently in children. A scaphoid fracture usually results from a fall onto an outstretched hand, extended and radially deviated. Such fractures are often associated with sports activities, such as:
- Soccer
- Handball
- Cycling
- Skiing
- Combat sports
Symptoms of a Scaphoid Fracture
- During a medical history consultation, patients typically report falling onto an outstretched arm with the wrist in hyperextension.
- Initial symptoms of a scaphoid fracture include pain in the dorsal wrist area.
- The pain is accompanied by swelling on the radial side of the wrist and limited joint mobility.
- Diagnosis often relies on identifying characteristic symptoms, such as pain in the anatomical snuffbox and pain when compressing the thumb and index finger.
- Precise imaging via X-rays in multiple views is essential, followed by detailed analysis. Despite its frequency, diagnosing this injury can be challenging.
- In some cases, magnetic resonance imaging (MRI) is helpful for accurate fracture assessment and evaluating the vitality of bone fragments.
How Common Are Scaphoid Fractures?
A scaphoid fracture is the most frequent wrist fracture, accounting for approximately 70% of all wrist fractures and about 15% of all bone fractures.
What Causes Scaphoid Fractures?
Any trauma to the wrist can result in a scaphoid fracture. The most common causes include:
- Falls
- Injuries
- Car accidents
Sports Commonly Associated with Scaphoid Fractures:
- Skiing
- Cycling
- Soccer
- Handball
- Combat sports
How Long Does it Take for a Scaphoid Bone to Heal?
The average healing time for a scaphoid fracture is 12 weeks. However, this depends on the treatment method and whether a bone graft is necessary.
Treatment for Scaphoid Fractures
Conservative Treatment:
- A non-displaced scaphoid fracture is treated conservatively with immobilization in a cast for 6–12 weeks.
- In competitive athletes, stable fractures may be treated surgically. After applying a cast, patients may return to activity after two weeks, but a supportive brace is required until bone healing is confirmed on X-rays.
Surgical Treatment:
Surgical intervention is required for:
- Displacement greater than 1 mm
- Comminuted fractures
- Proximal pole fractures
- Delayed diagnosis and treatment
- Angular displacement of fragments
Unstable fractures with displacement require reduction and internal fixation. Conservative treatment in such cases carries the risk of improper healing.
Rehabilitation After a Scaphoid Fracture
Rehabilitation after a scaphoid fracture lasts from several weeks to six months. Treatment focuses on gradually restoring proprioception and neuromuscular coordination. During this time, the hand should not be overloaded, e.g., by carrying heavy objects.
Prognosis
Despite proper diagnosis and early treatment, this injury is associated with a high rate of complications.
Most distal pole fractures heal with cast immobilization.
Non-displaced waist fractures or fractures with displacement under 1 mm are considered stable and can be treated conservatively.
Proximal pole fractures carry a risk of nonunion (pseudarthrosis) exceeding 50%.
Return to physical activity after stabilization of an unstable fracture depends on the quality of fixation during surgery. Full return to sports is possible when X-rays or MRI confirm complete bone healing.
After healing, intensive rehabilitation is usually necessary to regain full wrist range of motion.
Can a Scaphoid Fracture Heal Without Treatment?
Symptoms such as pain, swelling, and tenderness should never be ignored. Even if they appear minor, medical consultation is essential. Untreated scaphoid fractures can lead to serious complications, such as:
Acute Compartment Syndrome (ACS): A condition in which pressure increases within a muscle compartment.
Bone necrosis
Arthritis of the hand and wrist
How to Reduce the Risk of a Scaphoid Fracture:
- Use appropriate protective equipment during sports.
- Always wear seat belts in vehicles.
- Maintain cleanliness and organization at home and work to prevent tripping and falling.
- Follow a bone-healthy diet.
Related Articles:
Learn about other possible hand and wrist injuries.
References:
- Acute Fractures of the Scaphoid - Ring, David MD; Jupiter, Jesse B. MD; Herndon, James H. MD, MBA - Journal of the American Academy of Orthopaedic Surgeons: July 2000 - Volume 8 - Issue 4 - p 225-231
- Ortho Bullets - Scaphoid Fracture - Matthew J. Steffes MD
- National Library of Medicine - Scaphoid Wrist Fracture - Zara Hayat; Matthew Varacallo. - 2022
