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Fracture of scaphoid bone: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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ICD-10 code
S62.0. Fracture of the scaphoid bone of the hand.
What causes a fracture of the scaphoid bone of the hand?
Fractures of scaphoid bone occur, as a rule, when falling on an elongated arm, with an emphasis on the wrist. Usually, the bone breaks into two parts of approximately the same size, only a fractured fragment will break down if the tubercle fractures.
Symptoms of a scaphoid bone fracture
The clinical manifestations of fractures of the scaphoid bone are rather scarce, which, apparently, becomes the frequent cause of errors in the diagnosis. Beginners and doctors who are not wary of damage to the bones of the wrist, fractures of the scaphoid bone remain largely unrecognized: they are regarded as a bruise of the wrist joint.
Complaints about pain in the wrist joint, restriction of its functions should suggest the possible damage to the bones of the wrist.
Diagnosis of scaphoid bone fracture
Anamnesis
In the history - an indication of an appropriate injury.
Examination and physical examination
On examination, the swelling from the radial side of the joint is revealed in the zone of the "anatomical snuff-box". Here, pain is noted during palpation and rear extension of the hand. The axial load on the 1st finger causes pain in the point of the scaphoid bone. Movement in the radiocarpal joint is limited and painful, especially when the wrist is diverted to the radial and posterior sides.
Laboratory and instrumental research
If there is a suspicion of a fracture of the scaphoid bone, it is necessary to perform radiography in two, and preferably in three projections: straight, lateral and semi-profiled. In some cases, with a clear clinical picture on radiographs, fractures are not found even with the help of a magnifying glass. In such cases, one should adhere to tactics, as in the fracture of the scaphoid bone. It is necessary to impose a plaster bandage for 10-14 days, and then remove the plaster and repeat the X-ray examination. During this time, the bone becomes damaged, the gap between the fragments increases and becomes visible on the radiographs.
[Treatment of a scaphoid bone fracture
Conservative treatment of scaphoid bone fracture
Treatment is predominantly conservative. After introducing into the fracture site, 10-15 ml of a 1% solution of procaine is made by comparing the fragments by traction for the hand, flexing it to the palm and ulnar leads. The pressure on the bone fragments in the area of the "anatomical snuffbox" completes the reposition. Apply a circular gypsum dressing from the elbow joint to the metacarpophalangeal articulations in the functionally advantageous position of the hand (the position of the brush covering the tennis ball).
After 3-5 days, UHF is prescribed, a static contraction of the muscles under the gypsum, exercise therapy, stimulating physiotherapy on the symmetrical parts of the healthy limb. After 2.5-3 months, the bandage is removed and the radiograph is checked. If consolidation does not occur, immobilization is continued until 4-6 months. After the cessation of fixation, a course of rehabilitation treatment is prescribed.
Surgical treatment of scaphoid bone fracture
If closed reposition in hospital conditions fails, and also with non-fractured fractures and false joints, surgical treatment is indicated. The operation consists in an open reposition and attachment of fragments. The optimal fixation is a pin from the autostylicity, or even better if it is taken on the feeding vascular pedicle. Another microsurgical operation is to feed the feeding vessels to the damaged bone, it also gives good results. In some cases, with false joints and even aseptic scaphoid necrosis of the scaphoid bone, the function of the wrist joint remains on the background of the deforming arthrosis, and the pain syndrome is absent or insignificant. Operative treatment in such patients should be avoided. If the limitations of joint functions and the expressed pain syndrome are revealed, endoprosthetics of the scaphoid bone are performed. In rare cases, arthrodesis of the wrist joint is produced.
Estimated period of incapacity for work
Recovery of disability occurs after 4-8 months.
Prognosis of scaphoid bone fracture
A favorable outcome is more common with fractures without displacement, fragments. But in these cases, too, slow consolidation is possible, a false joint can form, or aseptic scaphoid necrosis may develop due to circulatory disorders. In the case of the development of the last two complications, patients are referred for inpatient treatment to the trauma department, and if possible, to the department of microsurgery or hand surgery.