The wrist consists of seven carpal bones, which are all connected to each other with various ligaments. The carpal bones form two rows of carpal bones and two joint lines. The scaphoid is the largest carpal bone. It is located on the thumb side of the carpus and functions as a link between the first and second row of the carpus. This makes it susceptible to injury and the carpal bone that fractures most frequently.
Scaphoid fractures are most commonly caused by a fall onto the outstretched hands. Sometimes there are cavities (cysts) in the bone that promote a fracture. Wrist dislocations can also lead to a fracture of the scaphoid bone (perilunate dislocation fracture).
As the blood supply to the scaphoid is not very good, the bone takes a long time to heal. If the fracture is not treated consistently, there is a high risk that it will not heal and a false joint (pseudarthrosis) will develop between the fracture fragments. Untreated scaphoid pseudarthrosis often leads to malformation of the bone with premature wear of the wrist.
The symptoms of a scaphoid fracture differ from the symptoms of scaphoid pseudarthrosis.
There is pain on the thumb side of the wrist. Wrist mobility is typically painfully restricted and there may be swelling. Axial pressure on the thumb can increase the pain.
Initially, there is often only relatively minor pain on the thumb side of the wrist, which occurs particularly with greater strain, for example when leaning on the hands. The mobility and maximum strength in the fist closure may be somewhat limited. Later, as wrist irritation increases, pain occurs even with minor strain. The final stage is wear and tear of the cartilage in the wrist.
The clinical examination reveals the suspected diagnosis. In addition, various X-ray images are taken. If the X-ray findings are inconclusive, a computerized tomography or MRI is performed. In the case of special fractures, magnetic resonance imaging may also be indicated in order to assess the blood flow.
Scaphoid pseudarthrosis is practically always visible on normal x-rays, as it appears as a gap between the bone fragments. Computer tomography of both wrists is usually carried out in order to plan the operation precisely. The reconstruction can then be planned on the basis of the healthy side. If the blood supply to the bone fragments is to be assessed, an MRI can be performed.
A scaphoid fracture is treated by immobilization in plaster or surgery. Surgery is necessary for scaphoid pseudarthrosis.
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