These areas of the scaphoid do not have a very good blood supply, as explained above. If the scaphoid is broken (but non-displaced) in the middle of the bone (waist) or closer to the forearm (proximal pole), healing can be more difficult. Treatmentįor some fractures, a cast that covers the forearm, wrist, and thumb (called a thumb spica cast) may be used to help keep the bone fragments in place while they heal.įracture near the forearm.
Your doctor may use information from the CT scan to help determine your treatment plan. A CT scan can be helpful in revealing a fracture of the scaphoid and can also show whether the bones are displaced. An MRI can sometimes show a fracture of the scaphoid before it can be seen on X-ray.Ĭomputerized tomography (CT) scan. Your doctor may order an MRI to learn more about the bones and soft tissues in your wrist. During this waiting period, you should wear your splint or cast and avoid activities that might cause further injury. Often, scaphoid fractures become visible on X-ray only after a period of time. If your doctor suspects you have a fracture but it is not visible on X-ray, they may recommend that you wear a wrist splint or cast for 2 to 3 weeks and then return for a follow-up X-ray. In some cases, a scaphoid fracture does not show up on an X-ray right away. An X-ray will also help your doctor determine if you have any other fractures or dislocations. Your doctor will likely order an X-ray to help determine whether you have a scaphoid fracture and whether the broken pieces of bone are displaced. X-rays provide images of dense structures, such as bone. With most fractures, there will be tenderness directly over the scaphoid in the anatomic snuffbox. Your doctor will also examine your wrist. May talk with you about your general health.This phenomenon, called “avascular necrosis,” can cause long-term problems in the wrist. In fact, there is a risk that fractures of the proximal scaphoid will completely disrupt the blood supply, causing part of the scaphoid to necrose, or die. For this reason, fractures of the distal scaphoid heal much more quickly than fractures of the proximal scaphoid. However, the blood supply to the scaphoid runs “backwards”: Blood enters the part of the scaphoid closest to the thumb (distal) and runs back toward the part of the scaphoid closest to the body (proximal). This direction of flow is found in most bones in the arms and legs, with the blood running from the part of the bone that is closest to the body to the part of the bone that is closest to the fingers or toes. Throughout the body, blood runs from the heart to the extremities (arms and legs) - from close to the body (proximal) to the fingers and toes (distal). The red arrows indicate the location of the anatomic snuffbox.Īs mentioned above, the scaphoid has a poor blood supply. Photograph and X-ray showing the location of the scaphoid in the wrist. Often referred to as the "anatomic snuffbox," this area is typically where you feel the most tenderness or pain when a scaphoid fracture occurs. It is located at the base of the hollow made by the thumb tendons on the back of the wrist. The scaphoid bone can most easily be identified when your thumb is held in a "hitch-hiking" or "thumbs-up" position. Smooth and unrestricted (free) motion of the scaphoid is necessary to allow for optimal motion of the wrist. The scaphoid is especially important to wrist function because it links the proximal row of carpal bones (the bones closer to the radius and ulna) to the distal row of carpal bones (the bones closer to the fingers). The word "scaphoid" comes from the Greek term for "boat." The scaphoid bone resembles a boat with its relatively long and curved shape. The bone is important for both motion and stability of the wrist joint. The scaphoid bone is one of the carpal bones on the thumb side of the wrist, just above the radius. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.
Reproduced from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. The scaphoid is one of the small carpal bones in the wrist.
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