MANUAL MINORS
A scaphoid fracture is a common wrist injury involving the scaphoid bone in the carpus, located at the base of the thumb. It typically occurs from a fall onto an outstretched hand and is most frequent in young adults. Due to the limited blood supply to this bone, scaphoid fractures carry a high risk of complications such as non-union or avascular necrosis.
Diagnosis
The diagnosis is based on:
Pain in the anatomical snuffbox, the area between the thumb and wrist, especially when palpating the region.
Swelling and limited movement of the wrist and thumb.
X-rays may not show the fracture in the first 1-2 weeks, so additional tests like CT scans, MRI, or repeat X-rays after two weeks may be needed in cases of high suspicion.
Differential Diagnosis
Condition | Key Differences |
|---|---|
Wrist Sprain | Pain without a visible fracture on initial X-rays, typically improves within a few days. |
Colles’ Fracture | Distal radius fracture with dorsal deformity, not in the anatomical snuffbox region. |
Fracture of Other Carpal Bones | Pain in different areas of the wrist, visible on X-rays. |
Post-Traumatic Arthritis | Chronic pain and stiffness following trauma, without evidence of acute fracture. |
Emergency Management
Immediate immobilisation with a wrist splint or cast in cases of clinical suspicion, even if the initial X-ray is negative.
Analgesia and anti-inflammatory medication to control pain.
Repeat X-rays after 1-2 weeks if pain persists, or consider advanced imaging like CT or MRI.
Definitive Treatment
The treatment depends on the type of fracture:
Non-displaced fractures: Managed with immobilisation in a short or long arm cast for 6-12 weeks, depending on the location (proximal, middle, or distal) of the fracture.
Displaced or unstable fractures: Usually require surgical fixation with screws to ensure proper alignment and healing of the bone.
Rehabilitation is essential to restore wrist mobility and prevent stiffness after immobilisation. Poorly treated scaphoid fractures may lead to complications such as avascular necrosis or non-union, which can cause chronic pain and osteoarthritis.
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