Scaphoid Fracture: Overview, Causes, and Rehab
What is a Scaphoid Fracture and What Causes It?
A scaphoid fracture is a type of wrist injury involving a broken bone in one of the 8 carpal bones located in the wrist. This injury typically occurs when a significant force is applied to an extended wrist, such as falling onto an outstretched hand (Carpenter et al., 2014). The fracture happens due to entrapment of the scaphoid proximal pole between the capitate, radius, and palmar capsule, which allows the distal pole to move freely (Carpenter et al., 2014).
Common Symptoms and Signs Symptoms commonly experienced with a scaphoid fracture include (Carpenter et al., 2014):
- Clamp sign
- Deep and dull ache in the radial side of the wrist
- Localized swelling and bruising in the wrist and/or anatomical snuffbox
- Tenderness on the radial side of the wrist/anatomical snuffbox during palpation
- Pain triggered by pinching/gripping movements, thumb compression, and resisted pronation/supination
Risk Factors
Several risk factors for scaphoid fractures have been identified, including (Williams, Jupiter & Maassen, 2019):
- Age between 18-30 years
- Male sex
- Participation in contact sports that increase the risk of falling
Treatment Options
Treatment approaches depend on the type and location of the fracture. Non-displaced fractures located distally usually heal well with strict immobiliszation in a well-molded short arm thumb spica or a long/short arm cast for approximately 6 weeks (Phillips, Reibach & Slomiany, 2004). Surgical intervention with screw fixation may be considered for faster recovery, particularly for athletes wanting to return to sport (Goffin, Liao & Robertson, 2019). Displaced fractures may require operative treatment along with splinting to promote proper healing (Phillips, Reibach & Slomiany, 2004). Healing time can vary depending on the location of the fracture, ranging from 6-8 weeks for distal scaphoid fractures, 8-12 weeks for middle fractures, to 12-24 weeks for proximal fractures (Hayat & Varacallo, 2021).
Physiotherapy and Rehab
Post-fracture physiotherapy plays a crucial role in the rehabilitation process, aiming to improve wrist range of motion, strength, and functional restoration (Buijze & Jupiter, 2018). During the initial immobilization period, it’s essential to manage swelling and prevent stiffness by elevating the hand and performing active finger, elbow, and shoulder movements (Hayat & Varacallo, 2021). After immobilization, the wrist may be stiff, and exercises involving wrist supination and pronation are important to restore range of motion and strength (Hayat & Varacallo, 2021). Manual therapy, including joint mobilizations to radiocarpal, radioulnar, and carpal joints, along with massage, can also be beneficial in reducing stiffness (Buijze & Jupiter, 2018). In some cases, physiotherapists may recommend a removable splint for an additional 6 weeks, especially for patients participating in high-risk activities that may lead to wrist injuries (Hayat & Varacallo, 2021).
Other Causes
Scaphoid fractures can also result from road traffic incidents or traumatic events during contact sports, such as tackling, where excessive force is applied to the scaphoid bone (Carpenter et al., 2014).
References
Buijze, & Jupiter, J. B. (2018). Scaphoid fractures : evidence-based management. Elsevier.
Carpenter, C. R., Pines, J. M., Schuur, J. D., Muir, M., Calfee, R. P., & Raja, A. S. (2014). Adult scaphoid fracture. Academic Emergency Medicine, 21(2), 101-121.
Goffin, J. S., Liao, Q., & Robertson, G. A. (2019). Return to sport following scaphoid fractures: A systematic review and meta-analysis. World journal of orthopedics, 10(2), 101.
Hayat, Z., & Varacallo, M. (2021). Scaphoid wrist fracture. In StatPearls [Internet]. StatPearls Publishing.
Phillips, T. G., Reibach, A., & Slomiany, W. P. (2004). Diagnosis and management of scaphoid fractures. American family physician, 70(5), 879-884.
Williams, R., Jupiter, D. C., & Maassen, N. H. (2019). The incidence and risk factors of scaphoid fracture associated with radial head and neck fracture in trauma patients. JAAOS Global Research & Reviews, 3(5).