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Last reviewed: 05.07.2025
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ICD-10 code
S62.0. Fracture of scaphoid bone of hand.
What causes a scaphoid fracture?
Fractures of the scaphoid bone usually occur when falling on an outstretched arm, with support on the hand. Usually the bone breaks into two parts of approximately the same size, only when the tubercle is fractured does a significantly smaller fragment break off.
Symptoms of a scaphoid fracture
Clinical manifestations of scaphoid fractures are rather poor, which apparently is a frequent cause of diagnostic errors. In beginners and in doctors who are not alert to damage to the wrist bones, scaphoid fractures remain mostly unrecognized: they are assessed as a bruise of the wrist joint.
Complaints of pain in the wrist joint and limitation of its functions should suggest possible damage to the wrist bones.
Diagnosis of a fracture of the scaphoid bone of the hand
Anamnesis
The anamnesis indicates a corresponding injury.
Inspection and physical examination
During examination, swelling is detected on the radial side of the joint in the "anatomical snuffbox" zone. Pain is also noted here during palpation and dorsal extension of the hand. Axial load on the 1st finger causes pain at the point of the scaphoid bone. Movements in the wrist joint are limited and painful, especially when the hand is deviated to the radial and dorsal sides.
Laboratory and instrumental studies
If a fracture of the scaphoid bone is suspected, it is necessary to perform an X-ray in two, and better yet, three projections: direct, lateral and semi-profile. In some cases, with an obvious clinical picture on the X-rays, the fracture is not found even with a magnifying glass. In such cases, the tactics should be followed as for a fracture of the scaphoid bone. It is necessary to apply a plaster cast for 10-14 days, and then remove the plaster and repeat the X-ray examination. During this time, bone rarefaction occurs, the gap between the fragments increases and becomes visible on the X-rays.
[ Treatment of a fracture of the scaphoid bone of the hand
Conservative treatment of scaphoid fracture of the hand
Treatment is mainly conservative. After 10-15 ml of 1% procaine solution is injected into the fracture site, the fragments are aligned by traction on the hand, bending it to the palmar side and ulnar abduction. Reposition is completed by applying pressure to the bone fragments in the area of the "anatomical snuffbox". A circular plaster cast is applied from the elbow joint to the metacarpophalangeal joints in a functionally advantageous position of the hand (the position of the hand grasping a tennis ball).
After 3-5 days, UHF, static muscle contraction under plaster, exercise therapy, stimulating physiotherapy on symmetrical areas of the healthy limb are prescribed. After 2.5-3 months, the bandage is removed, and control radiography is performed. If consolidation has not occurred, immobilization is continued for 4-6 months. After the fixation is stopped, a course of rehabilitation treatment is prescribed.
Surgical treatment of scaphoid fracture of the hand
If closed reduction in a hospital setting fails, as well as in case of ununited fractures and pseudoarthrosis, surgical treatment is indicated. The operation consists of open reduction and fastening of fragments. The optimal fixator is considered to be a pin made of autogenous bone, and even better if it is taken on a feeding vascular pedicle. Another microsurgical operation consists of bringing feeding vessels to the damaged bone, it also gives good results. In some cases, with pseudoarthrosis and even aseptic necrosis of the scaphoid bone against the background of deforming arthrosis, the functions of the wrist joint are preserved, and the pain syndrome is absent or insignificant. Surgical treatment in such patients should be avoided. If limited joint functions and severe pain syndrome are detected, endoprosthetics of the scaphoid bone is performed. In rare cases, arthrodesis of the wrist joint is performed.
Approximate period of incapacity
Restoration of working capacity occurs within 4-8 months.
Prognosis of scaphoid fracture
A favorable outcome is more common with fractures without displacement, fragments. But even in these cases, slow consolidation is possible, a false joint may form, or aseptic necrosis of the scaphoid bone may develop due to circulatory disorders. In the event of the development of the last two complications, patients are sent for inpatient treatment to the trauma department, and if possible, to the microsurgery or hand surgery department.