The scaphoid is the most commonly fractured of the eight carpal bones. It is also called the navicular bone. It occurs more often in young men. Scaphoid fractures are notorious for initially not showing up on a regular x-ray and thus causing a delay or failure to make the diagnosis. The scaphoid has a poor blood supply and can be very difficult to heal, depending on the location of the fracture. Proximal pole fractures tend to be the most difficult to heal and often lead to non-union and osteoarthritis. (Figure 1)

The primary mechanism of injury is a fall on the outstretched hand with an extended and radially deviated wrist. The patient presents with pain, decreased range of motion and bruising. Tenderness to palpation in the anatomic snuffbox (Figure 2, 3) is highly sensitive for a fracture of the scaphoid but does not necessarily mean there is a fracture for sure. If the x-ray fails to reveal a fracture, an MRI (Figure 4), CTscan (Figure 5) or bone scan may be obtained.

Treatment:
For acute non-displaced fractures, a long arm cast may be applied including the thumb for 12 weeks. There is a trend towards treating these fractures more aggressively with surgery due to the high incidence of non-unions. Those surgeries can be performed percutaneously with a very small incision and a screw introduced into the scaphoid. (Figure 6)

For displaced fractures, a 2 inch incision is made on the top or bottom of the wrist, depending on the location of the fracture. A screw is introduced into the scaphoid. Bone graft may also be needed and can be obtained from the distal radius through the same incision. The patient is placed in a short arm thumb spica splint after surgery which is replaced by a cast 2 weeks later. A bone stimulator may also be ordered to help promote healing of the bone. It is important to know that a scaphoid fracture, especially a non-union, treated with surgery can take as much as 26 weeks to heal.

At Central Jersey Hand Surgery, our doctors are experts in treating the variety of fractures that occur in the scaphoid. The surgery is typically performed in one of our 3 ambulatory surgery centers under general anesthesia followed by a brief stay in the recovery home and a discharge the same day. Physical therapy is initiated once the cast is removed and healing is confirmed through physical examination, serial x-rays and sometimes a CT Scan.