Scaphoid fractures usually occur due to a fall on the out-stretched hand. Most patients complain of pain in the wrist with difficulty in gripping objects.
The biggest problem in diagnosis is that- Most Scaphoid fractures may not be apparent on the initial X-ray. So, the patients are often treated as a case of Wrist Sprain.
Clinical suspicion is the guide to treatment.
Signs- Tenderness in the Anatomical Snuff Box between the tendons on the back of wrist at the base of thumb.
For patients presenting with significant pain and positive signs, a Scaphoid cast should be applied at the first evaluation even if the Xray findings are negative. X-ray repeated after 10 days to 2 weeks may show a fracture line across the Scaphoid. If repeat Xray does not show any fracture line at 3 weeks, the plaster may be safely removes and crepe bandage applied.
Most un-displaced fractures can be managed conservatively with a plaster cast for a period ranging from 10-12 weeks. Serial weekly x rays are done to diagnose re-displacement within the plaster.
For displaced Scaphoid fractures or those that re-displace within the plaster, surgery may be required for good results. Poorly treated fractures may go into non-union; this causes persistent weakness in grip strength.
Surgery is performed for displaced fractures or established non-unions.
It consists of exposure of the fracture and stabilization with screws which are sunk underneath the surface.
For non-unions, bone grafting may also be required in addition to fixation with a Herbert screw.
Poorly treated cases may cause Degenerative arthritis of the wrist joint in late stages.
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