Understanding Scaphoid Fracture: Causes, Symptoms, Prevention, and Effective Treatments
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on July 16, 2024
Scaphoid fractures are common injuries affecting the wrist, often resulting from falls onto an outstretched hand. The scaphoid bone, situated at the base of the thumb side of the wrist, plays a crucial role in wrist stability and motion. Early diagnosis and treatment of scaphoid fractures are paramount due to their propensity for complications such as nonunion or avascular necrosis, which can lead to long-term wrist dysfunction if not managed promptly (Garcia-Elias & Dobyns, 2006; Dias & Singh, 2005).
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What is a scaphoid fracture?
A scaphoid fracture refers to a break in the scaphoid bone, a small, boat-shaped bone located on the thumb side of the wrist. This bone is critical for maintaining the stability of the wrist joint and facilitating its smooth movement. When fractured, especially in cases where the fracture is not promptly identified and treated, complications such as impaired blood supply to the bone (avascular necrosis) can occur, potentially leading to long-term wrist pain and dysfunction.
Causes of scaphoid fractures
Scaphoid fractures typically occur due to falls onto an outstretched hand, where the force of impact is transmitted through the wrist. This mechanism commonly happens during activities such as slipping on ice or falling from a height with the hand extended to break the fall Sports injuries also contribute significantly to scaphoid fractures, particularly in contact sports like football, rugby, and hockey, where direct trauma to the wrist can occur during collisions or falls. High-impact trauma, such as motor vehicle accidents or falls from significant heights, can also result in scaphoid fractures due to the forces involved.
Risk factors
Several risk factors increase the likelihood of sustaining a scaphoid fracture. Participation in contact sports or activities that involve high-risk movements and potential falls, such as motorcycle riding or skateboarding, heightens the risk of wrist injuries including scaphoid fractures.
Osteoporosis, a condition characterized by reduced bone density and strength, also increases susceptibility to scaphoid fractures. Weakened bones are less able to withstand the impact forces that can lead to fracture upon falling onto an outstretched hand or other traumatic incidents.
Signs and symptoms of scaphoid fractures
Scaphoid fractures typically present with localized pain and tenderness in the anatomical snuffbox, a depression on the thumb side of the wrist. Patients may also experience swelling and difficulty moving the wrist, especially with activities that involve gripping or twisting motions. These symptoms can worsen with wrist movement or when bearing weight on the hand
Prevention of scaphoid fractures
Preventing scaphoid fractures involves several key strategies aimed at reducing the risk of falls and trauma to the wrist. Wearing protective gear, such as wrist guards during sports activities that carry a high risk of falls (e.g., skating, snowboarding), can help cushion impact and protect the wrist from injury. Additionally, practicing proper techniques during sports and activities that involve the hands and wrists, such as avoiding excessive force during falls and ensuring proper warm-up and stretching routines, can decrease the likelihood of injury. Maintaining overall bone health through adequate calcium and vitamin D intake, as well as regular weight-bearing exercise, also contributes to reducing the risk of fractures.
Diagnostics of scaphoid fractures
Diagnosing scaphoid fractures can be challenging due to their subtle symptoms and the bone's complex anatomy. Initial assessment typically involves a thorough physical examination to evaluate for tenderness in the anatomical snuffbox and any signs of swelling or deformity.
Imaging plays a crucial role in confirming the diagnosis. X-rays are often the first-line imaging modality, but they may not immediately detect early fractures, especially if the fracture is non-displaced. In such cases, follow-up imaging with MRI or CT scans may be necessary to accurately assess the extent of the injury and guide treatment decisions.
Treatment options for scaphoid fractures
Non-surgical treatments:
For non-displaced or minimally displaced fractures, immobilization with a cast or splint is commonly employed to allow the bone to heal properly. Anti-inflammatory medications may be prescribed to manage pain and reduce inflammation during the healing process.
Surgical options:
Surgery is considered when fractures are displaced, fail to heal with non-surgical methods, or if there is a risk of complications such as avascular necrosis. Surgical procedures typically involve internal fixation, where screws or pins are used to stabilize the fracture and promote healing. In cases of non-union or avascular necrosis, bone grafting may be necessary to stimulate bone healing and restore integrity to the scaphoid bone .
Post-surgery, patients undergo a period of immobilization followed by rehabilitation to regain wrist function gradually. Physiotherapy plays a crucial role in this process.
Physiotherapy for scaphoid fractures
Physiotherapy plays a crucial role in the comprehensive rehabilitation of scaphoid fractures, aiming not only to facilitate recovery but also to minimize the risk of long-term complications. Here's an elaboration on the role and techniques involved in physiotherapy for scaphoid fractures:
Role of physiotherapy
Pain management: Physiotherapists employ various modalities and techniques to alleviate pain associated with scaphoid fractures. This may include gentle manual therapy techniques to reduce muscle tension and improve circulation around the affected area. Additionally, they may use modalities such as ultrasound or electrical stimulation to help manage pain and promote tissue healing.
Improving wrist mobility: Immobilization, whether through casting or splinting, can lead to stiffness and reduced range of motion in the wrist joint. Physiotherapists design specific exercises and stretches aimed at restoring normal wrist mobility. These exercises often begin with gentle movements to gradually increase flexibility without compromising healing structures.
Restoring strength and function: After a period of immobilization, the muscles around the wrist and hand may weaken. Physiotherapy focuses on progressively strengthening these muscles through targeted exercises. These exercises typically include grip strengthening activities, wrist curls, and resistance training using therapeutic bands or weights. Strengthening these muscles not only restores function but also supports the healing process of the scaphoid bone.
Preventing complications: Long-term complications such as stiffness, weakness, and reduced grip strength can arise if rehabilitation is incomplete or inadequate. Physiotherapists play a critical role in preventing these complications through consistent monitoring and adjustment of rehabilitation programs. They educate patients on proper techniques for daily activities and provide ergonomic advice to minimize strain on the healing wrist.
Techniques used in physiotherapy
Manual therapy: Hands-on techniques such as soft tissue mobilization, joint mobilizations, and myofascial release are used to improve tissue flexibility, reduce pain, and enhance joint mobility.
Therapeutic exercises: Tailored exercise programs are designed to address specific deficits and goals of each patient. These may include range of motion exercises, stretching, strengthening exercises for the wrist and hand muscles, and functional activities to simulate daily tasks.
Modalities: Physiotherapists may incorporate modalities such as heat or ice therapy, ultrasound, electrical stimulation (e.g., TENS), or laser therapy to further promote healing and manage symptoms.
Benefits of physiotherapy
Effective physiotherapy intervention for scaphoid fractures not only accelerates recovery but also enhances overall outcomes by:
Reducing pain: Managing pain effectively throughout the healing process.
Improving function: Restoring optimal wrist mobility and strength.
Preventing recurrence: Educating patients on injury prevention strategies and safe return to activities.
Physiotherapy is essential in the holistic management of scaphoid fractures, addressing pain relief, mobility restoration, and strength rehabilitation. It forms a critical component of comprehensive care, ensuring patients achieve maximal recovery and minimize the risk of long-term complications.
Conclusion
Understanding scaphoid fractures is essential for timely diagnosis and appropriate treatment. Early intervention, whether through non-surgical methods or surgery when necessary, significantly improves outcomes. Physiotherapy plays a crucial role in recovery, emphasizing the importance of comprehensive rehabilitation to restore wrist function and prevent future complications. Individuals experiencing wrist pain or injury should seek prompt medical evaluation to ensure proper diagnosis and management.
References:
Steinmann, S. P., & Adams, J. E. (2006). Scaphoid fractures and nonunions: diagnosis and treatment. Journal of Orthopaedic Science, 11, 424-431.
Court-Brown, C. M., & Caesar, B. (2006). Epidemiology of adult fractures: A review. Injury, 37(8), 691-697. https://doi.org/10.1016/j.injury.2006.04.130
Cummings, S. R., & Melton, L. J. (2002). Epidemiology and outcomes of osteoporotic fractures. The Lancet, 359(9319), 1761-1767. https://doi.org/10.1016/S0140-6736(02)08657-9
Rhemrev, S. J., Ootes, D., & Beeres, F. J. P. (2010). Current methods of diagnosis and treatment of scaphoid fractures. International Journal of Emergency Medicine, 3(1), 11-15. https://doi.org/10.1007/s12245-009-0116-7
Related links:
Understanding Wrist Injuries: Causes, Symptoms, Prevention, and Effective Treatments
Understanding De Quervain's Tenosynovitis: Causes, Symptoms, Prevention, and Effective Treatments
Understanding Ganglion: Causes, Symptoms, Prevention, and Effective Treatments
Understanding Wrist Fracture: Causes, Symptoms, Prevention, and Effective Treatments
Understanding Wrist Sprain: Causes, Symptoms, Prevention, and Effective Treatments
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.