Scaphoid (Navicular) Fractures of the Hand and Wrist
UW Health's Sports Medicine doctors in Madison, Wisconsin, treat a wide range of common athletic injuries, including scaphoid (navicular) fractures of the hand and wrist.
About Wrist Fractures
Fractures to the scaphoid bone, also known as the navicular bone, are the most common fractures in the wrist. The wrist is made up of the distal end of two long bones, the radius and the ulna, and eight small bones known as the carpal bones. One of these carpal bones is the scaphoid bone. The eight carpal bones form two rows of four bones that rest between the bones of the hand (the metacarpals) and the bones of the forearm (the radius and the ulna).
The scaphoid bone lies between the base of the thumb and the radius in a depressed area known as the “anatomical snuff box.” This point can be found by looking at the back of the hand and then moving the thumb away from the rest of the fingers. The “anatomical snuff box” appears as a depression at the base of the thumb and is bordered by tendons and the radius.
Typically, a scaphoid fracture occurs when the scaphoid is compressed against a bone of the forearm (usually the radius). This often occurs with direct contact to the palm of the hand such as a fall on the hand with the arm outstretched (Figure 1), which causes the wrist to be extended forcefully; this “pinches” the scaphoid, causing it to fracture.
The most common signs and symptoms of a scaphoid fracture include pain, swelling and tenderness over the thumb side of the wrist. There is noticeable tenderness to the touch over the “anatomical snuff box.” Crunchiness and pain with gripping motions are also common symptoms that may be found with such an injury. A scaphoid fracture may mistakenly be diagnosed as a sprain and not found on an x-ray upon initial examination. This fracture may be more accurately diagnosed with an MRI or bone scan if it does not appear on an X-ray.
Scaphoid fractures should be diagnosed early since much of the scaphoid bone has a poor blood supply and will not heal well with continued stress. Furthermore, if the scaphoid bone fractures and displaces (where two or more pieces of bone have moved away from one another), the odds of the bone healing appropriately without medical intervention are very small. If medical intervention does not occur soon enough and the blood supply is not reestablished, the bone may degenerate and necrosis (tissue death) of the bone may occur.
The treatment for scaphoid fractures depends largely on the severity and shape of the fracture line. Fractures that are not displaced (those where the break line is small) are immobilized. Some physicians prefer to immobilize patients with a long arm cast for six weeks and then shift to a short arm cast until healed. Other physicians advocate a short arm cast for three months followed by the use of a rigid splint for two months. Often, the injured person is able to resume activities as long as they remain immobilized and experience no discomfort during or after activity.
Non-displaced fractures that do not heal after three to four months often require surgical intervention or the use of other modalities, such as a bone stimulator.
Displaced fractures typically require surgery to repair the fracture. Surgery may require bone grafts, a screw and/or wires for adequate fixation. The patient is then placed in a short arm cast until the fracture is healed.
In the displaced and non-displaced fractures, the physician assesses healing and recommends activity levels based on symptoms as well as follow-up imaging (usually X-rays and/or bone scans).
Once activity is allowed, a supervised rehabilitation program begins that includes range-of-motion exercises and strengthening exercises of the hand, forearm and elbow. Exercises continue and progress until function is restored and optimized. Protective bracing during activities reduces stress on the wrist, and is commonly done for at least three months after starting rehabilitation.