Scaphoid Wrist Fracture
What is it: Scaphoid wrist fractures involve a fracture of one of the wrist bones.
How does it present: Patients with this injury often present after a fall on an outstretched hand. They may or may not have significant swelling in the area of the anatomic snuffbox and may complain of diffuse wrist pain.
Common exam findings: Patients with scaphoid fractures should have tenderness when palpating the anatomic snuffbox. They may also be uncomfortable with range of motion of the wrist. It is a commonly missed fracture; any discomfort in the anatomic snuffbox should prompt initial treatment for a scaphoid fracture and proper evaluation.
Tests and treatment: Some scaphoid fractures can be visualized on initial wrist x-rays. If no fracture is seen, but clinical exam is concerning for a scaphoid fracture, the patient should be treated in a thumb spica splint and re-evaluated in seven to ten days. If repeat x-rays still show no fracture and tenderness in the anatomic snuffbox is still present, the patient should be continued in a thumb spica cast or splint and more definitive evaluation with bone scan, CT, or MRI should be pursued. The blood supply to the scaphoid goes from distal scaphoid to proximal and is easily disrupted resulting in fractures that take several weeks to heal. Fractures to the distal pole of the scaphoid will often heal better than those of the proximal pole. Consider referral to orthopedics for fractures of the more proximal pole of the scaphoid or any fractures that are displaced as they have a high risk of avascular necrosis. When treating a non-displaced distal scaphoid fracture a long arm thumb spica cast should be considered for the first several weeks. If the fracture does not appear to be healing initially, referral for possible surgical intervention should be considered.