Scaphoid is the most important bone in the wrist. It is also known as “key stone “. Scaphoid is the most common carpal bone to fracture in the upper limb. You may be at higher risk of fracture if you participate in sports or use two wheeler.
It’s important to treat a broken bone as soon as possible. Otherwise, the bones might not heal, may heal in not so proper alignment, which might affect your ability to do everyday activities, such as writing , activities involving firm grip. Early treatment will also help minimize pain and stiffness.If you smoke, quit. Smoking can delay or prevent bone healing.
Scaphoid fracture is divided into three types depending on location
- Proximal pole fractures
- Fractures at the waist of scaphoid
- Distal pole or tuberosity fractures
Due to the peculiarity of blood supply, proximal pole fractures are difficult to unite without surgery. Fractures at the waist of the scaphoid have more healing potential. Stable fractures of the waist of the scaphoid and distal pole are treated with plaster. Unstable waist or distal pole fractures with less healing potential may require surgery to enhance fracture union.
Restricting the movement of a broken scaphoid in the wrist is critical to proper healing. To do this, you’ll likely need a splint or a cast. You’ll be advised to keep your hand above your elbow as much as possible to reduce swelling and pain.
To reduce pain, your doctor might recommend an over-the-counter pain reliever. Narcotic medication such as codeine is rarely needed. NSAIDs can help with pain but might also hamper bone healing, especially if used long term. Ask your doctor if you can take them for pain relief.
After your cast or splint is removed, you’ll likely need rehabilitation exercises or hand therapy to reduce stiffness and restore movement in your wrist. Rehabilitation can help, but it can take several months or longer for complete healing.
Even after reduction and immobilization with a cast or splint, your bones can shift. So your doctor will likely monitor your progress with X-rays. If your bones move, you might then need surgery, which can take the forms of:
- Closed reduction and pinning : Fracture will be aligned and temporarily held by pins until the fracture has healed after which the pins are removed.
- Closed reduction and percutaneous (through a very small wound) screw fixation
- Open reduction and internal fixation You might need surgery to implant screws to hold your bones in place while they heal. A bone graft might be used to help healing.
These options might be necessary if you have:
- A fracture in which the bone pieces move before they heal
- Loose bone fragments that could enter a joint
- Damage to the surrounding ligaments, nerves, or blood vessels
- Fractures or dislocations of other bones around scaphoid