Scaphoid (Navicular) Fractures of the Hand and Wrist
UW Health's Sports Medicine doctors treat a wide range of common athletic injuries.
Of all the bones in the wrist, fractures to the scaphoid bone, also known as the navicular bone, are the most common. The following describes the bony anatomy of the wrist, how a scaphoid fracture may be assessed and the treatment options for this injury.
The wrist is made up of two long bones, the radius and the ulna, and eight small bones known as the carpal bones, one of which 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 thumb side 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 (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).
This causes the wrist to be forcefully extended, “pinching” 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 snuffbox.” 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 a bone scan if it does not appear on an X-ray.
It is important that a scaphoid fracture be diagnosed early as much of the scaphoid bone has a poor blood supply and will not heal well with continued stress. Furthermore, if the scaphoid bone fractures, such that the fracture 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, and the use of other modalities, such as electrical stimulation.
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 long cast for six weeks followed by a short arm cast until the fracture is healed.
In the displaced and non-displaced fractures, the patient’s symptoms, as well as follow-up imaging techniques (X-rays, bone scans), are used by the physician to determine the patient’s level of activity.
Once the physician clears the patient, he or she undergoes a supervised rehabilitation program that includes range-of-motion exercises and strengthening exercises of the hand, forearm and elbow. The patient will continue to do these exercises until the strength and motion of the injured arm returns to normal. The patient may continue to use a protective brace during activities that greatly stress the wrist, for three months or more, after initiating rehabilitation.
Some common exercises that are performed following removal of the cast are:
Wrist flexion:Hold a can of soup or a hammer handle in your hand with your palm facing up. Bend at the wrist moving your palm up. Lower the weight back to the starting position. Repeat this for 3 sets of 10. (Figure 2)
Wrist extension:Hold a can of soup or a hammer handle in your hand with your palm facing down. Bend at the wrist moving your palm up. Lower the weight back to the starting position. Repeat this for 3 sets of 10. (Figure 3)
Finger extensions:With a rubber band around your fingers, fan them out, then slowly return to neutral. Repeat this for 3 sets of 10. (Figure 4)
Supination and pronation: Bring your arm to your side. Bend your elbow to 90 degrees and turn your palm up. Hold a hammer tightly in your hand with the head of the hammer away from your body. Turn your hand over so your palm faces down and then turn the palm back up. Repeat this for 3 sets of 10. (Figure 5)
Ball squish:Hold a small squeezable ball in your hand. Close your fingers over the ball and squeeze it tightly for 5 seconds. Perform 15 times. (Figure 6)
* Exercises should be completed as part of a supervised rehabilitation program.