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Scaphoid Fractures

At Potter Rees Dolan, we deal with a number of motorcycle accident claims. With this, we find scaphoid fractures are quite common following motorcycle accidents in particular, but can also be commonly caused by a fall onto an outstretched hand.

The scaphoid bone is one of the carpal bones around the area of the wrist.

The symptoms often include pain and swelling around the wrist and tenderness over the thumb side of the wrist. Sometimes there can be tenderness to touch over the area known as the “anatomical snuffbox”.

Scaphoid fractures are categorised by location. They are often diagnosed by X-rays but it is important to remember that they are not always apparent on the initial X-rays and may not show up until 10 to 14 days after the injury.

In some cases, the fracture will become apparent following a review of the second set of X-rays but a fracture may not even be apparent then, in which case, a CT or MRI scan is likely to provide clearer resolution.

Treatment usually consists of providing a cast. If there has been some movement of the bone fragment(s), the scaphoid bone can heal in an incorrect position and you might need surgery to correct this. In some circumstances, a bone graft may also be needed to correct the deformity and to promote healing.

However, an important possible complication in scaphoid fractures is avascular necrosis. Avascular necrosis is usually visible on X-rays. This complication and the risk depends upon the location of the fracture. This is more common where a fracture occurs at the narrowest part of the scaphoid which is where the blood supply enters to the scaphoid bone.

If the blood supply is interrupted, it can leave part of the bone without a blood supply. Sometimes scaphoid fractures are mistakenly assumed to be a sprain and it may be that you are unknowingly applying pressure to the injured wrist. Correct diagnosis and prompt treatment of a scaphoid fracture can help to reduce these complications.

In cases where a scaphoid fracture has not been diagnosed or has not been treated properly, there is a risk of non-union where the bone is permanently broken. If the blood supply is affected or disrupted by a fracture, the bone may not heal and, if it is not treated correctly, there may also be a risk of developing osteoarthritis.

Read a blog from Helen Shaw on why these fractures are so common and so frequently missed on X-rays.

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