A scaphoid fracture can occur after a fall onto the hand and cause wrist pain that initially feels moderate. It's important to recognize this type of fracture because a delayed diagnosis can hinder bone healing. Therefore, it's important to understand why it often goes unnoticed and what the ideal treatment is for effective recovery.
What is a scaphoid fracture and why can it go unnoticed?
A scaphoid fracture affects one of the small bones that make up the wrist and can go unnoticed because its initial symptoms are often confused with those of a sprain, and some fractures are not visible in the first x-rays.
Where is the scaphoid bone and why is it key in the wrist?
The scaphoid bone is located on the thumb side of the wrist and is involved in the stability and mobility of the carpal joint.
Because it's a highly vascularized area, it can hinder the healing of certain fractures. That's why it's important to detect the injury and treat it properly for a successful recovery.
Falls with the hand supporting the body as a common cause of scaphoid fracture
One of the most frequent causes is falling with the hand outstretched to cushion the impact. This is where the force of the blow is transmitted from the palm to the wrist, causing the injury.
This mechanism can occur during an accidental fall or while playing sports, especially in activities where there is a risk of losing balance and instinctively supporting oneself with one's hand.
Why mild wrist pain doesn't always rule out a fracture
A scaphoid fracture doesn't always cause intense pain after the trauma, making it quite difficult to identify. The discomfort may resemble a sprain and be concentrated near the base of the thumb, so persistent pain after a fall should be evaluated, even if the patient can still move their wrist.
Symptoms of a scaphoid fracture that should be checked after a fall
Pain localized to the thumb side is one of the most characteristic and noticeable symptoms of this injury. Swelling and difficulty using the hand normally, especially when gripping objects or performing certain movements, may also occur.
Pain in the anatomical snuffbox as a typical sign of scaphoid
The anatomical snuffbox is a small depression located at the base of the thumb, visible when it is extended. Tenderness or pain in this area after a fall may suggest a scaphoid injury.
This sign alone does not confirm the fracture, so it must be complemented with a medical examination and any necessary imaging tests.
Swelling, loss of strength, and pain when moving the wrist after the blow
In addition to localized pain, it is common to observe some swelling in the area, a decrease in grip strength, and pain when moving the wrist or thumb. These symptoms may be mild in the first few hours, which underscores the importance of not basing a diagnosis solely on the intensity of the pain.
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Request a medical evaluationDiagnosis of a scaphoid fracture using X-ray, CT scan, or MRI
The diagnosis begins with a physical examination and, something very common in these cases, an X-ray.
As the American Academy of Orthopaedic Surgeons on scaphoid fracture, Some fractures may not be initially visible, so further imaging tests may be necessary to confirm or rule out the injury.
Why an initial X-ray may not show a scaphoid fracture
Some scaphoid fractures, especially those without displacement, can be difficult to identify on an X-ray taken immediately after the trauma.
Therefore, if the pain persists and there is suspicion on the part of the professional, immobilization should be applied and additional studies requested before ruling out the fracture.
When is a CT scan or MRI ordered if wrist pain persists?
Magnetic resonance imaging (MRI) is used to detect hidden fractures that did not appear on an initial X-ray. A computed tomography (CT) scan allows for a precise examination of specific characteristics of the fracture.
The choice of one test or another will depend on each case, the findings that appeared in the examination and the information that the specialist needs to obtain.
Risk of pseudoarthrosis when the scaphoid fracture is not detected
When a scaphoid fracture is not diagnosed and treated promptly, there is a high risk that the bone will not heal properly, leading to pseudoarthrosis. This complication, exacerbated by the limited blood supply to the scaphoid, can result in chronic pain, loss of mobility, and long-term degenerative changes in the wrist.
You can learn more about this and other complications associated with untreated wrist fractures in the article by Arthroscopy and endoscopy of the hand and wrist at Clínica Elgeadi, on our website.
Treatment and recovery of scaphoid fracture according to displacement
Treatment will depend on the location of the fracture, its stability, and the degree of displacement. While some injuries can heal simply with immobilization, others require surgical treatment to achieve effective healing and preserve wrist function.
Immobilization with a plaster cast or splint in stable scaphoid fractures
Stable, non-displaced fractures can be treated by immobilization with a plaster cast or splint for a period indicated by the specialist in charge, with the aim of keeping the bone protected while consolidation occurs.
During recovery, checks should be carried out to monitor the evolution of the fracture before gradually resuming mobility and weight-bearing on the wrist.
When to consider surgery for a displaced scaphoid fracture
When a fracture presents with displacement, instability, or affects the proximal pole, surgery using a compression screw is considered to stabilize the fracture and promote healing. The choice between conservative and surgical treatment is a subject of debate, as discussed in this article. Communication presented at the SERAM National Congress.
In Elgeadi Clinic We conduct an individualized assessment of each case to define the most appropriate and accurate treatment for each patient.
