Ask Dr. Geier – Scaphoid Fractures
Hello again! After my month away from the Ask Dr. Geier column, I am eager to answer more questions. Thanks for sending them to me as I am thrilled to interact with all of you and hopefully inform you as best I can.
I need to quickly remind my readers of two points about “Ask Dr. Geier.” Although I want to help you as much as I possibly can, I cannot provide specific medical information on my blog. Assuming you have a problem I treat (I am not a spine, hand or wrist surgeon, for instance), an appointment is the best – and only – way to review your MRI reports, make a diagnosis or recommendation for surgery, physical therapy or other treatment. Without performing a thorough examination and reviewing radiographic studies, I can’t provide a medical opinion.
However, I can and I will continue to answer questions about injuries and surgeries in general terms as I have done all along.
Also, if you would like a recommendation of surgeons near your area of residence, I highly recommend that you visit American Orthopaedic Society for Sports Medicine and use the Find a Doctor tool.
This week’s Ask Dr. Geier column addresses an injury that is often missed in sports. And, yes, you will notice that the reader does ask for a recommendation since I don’t perform hand and wrist surgery. I obliged because I happen to work with the best wrist surgeons in Charleston.
Thanks for understanding!
David
Dan in Charleston, SC asks:
I have a scaphoid fracture that I have had treated years ago and it still has not healed properly. I met with another local doctor who suggested two surgeries…first to go in a scope, second to correct the issue three weeks later.
I am against having two procedures done, and would prefer to have everything done at one time. Is this a type of injury you deal with and would you perform a corrective surgery? Or would you refer me to another doctor?
Thanks,
Dan
Unfortunately scaphoid fractures are more common in sports than we would like to see. The scaphoid is one of the main bones in the wrist, located just under the metacarpal at the base of the thumb. There are several ways to fracture the scaphoid, but most commonly athletes suffer this injury with a fall on the outstretched hand. I am not a hand or wrist surgeon, and I usually refer these injuries to my partners who are hand and wrist specialists, but I often examine acute wrist injuries that occur during games that I am covering. Unfortunately, I see these injuries not infrequently when they have been treated or diagnosed as “wrist sprains” and the appropriate imaging was not performed that would have diagnosed a fracture.
First of all, the location of pain is somewhat characteristic for a scaphoid fracture. Turn your wrist so that the thumb is facing up (toward the ceiling). Now you’re your thumb back toward your elbow, pulling it away from the other four fingers. You will see tendons at the base of the thumb surrounding a hollow area. This hollow area is called the “anatomic snuffbox.” A person with a wrist injury that has pain when he or she presses in this anatomic snuffbox should be concerned that the injury is really a scaphoid fracture. Whenever I find tenderness to palpation in this area specifically, I always obtain x-rays of the patient’s wrist.
If the patient’s history and physical examination and subsequent wrist x-rays show a scaphoid fracture, I think that aggressive treatment is indicated right away. Now I’m not saying that every scaphoid fracture needs surgery. If the fracture is non-displaced, it can often be treated in a cast. Whether or not this is a short-arm cast or long-arm cast is subject to debate among hand surgeons, so I would defer to their recommendations. If the fracture is displaced (meaning that it does not line up perfectly), surgery is usually indicated. Surgery usually consists of a small incision to line the fracture optimally and hold it in place with a screw down the length of the bone.
Treatment for scaphoid fractures?
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The main concern with missing a scaphoid fracture or nonoperative treatment of a displaced fracture is that the fracture might not heal (a nonunion). The blood supply to the scaphoid is tenuous, making the risk of nonunion significant. A loss of blood supply can cause what we call avascular necrosis of the scaphoid. Therefore if surgical treatment is indicated, I feel that a hand surgeon should perform it fairly quickly. If a nonunion occurs, there are surgical options. While again I would defer to the hand surgeons, I will say that the surgery usually involves some sort of bone grafting procedure with internal fixation with a screw. Whether or not this can be done arthroscopically or in one surgery versus two surgeries, I will leave that up to hand surgeons to provide more specific recommendations. The main point I want to emphasize is that athletes should have these certain wrist injuries evaluated quickly and treated appropriately.
C. David Geier Jr., M.D.
6 Comments
hi sir,
I am a patient of scaphoid injury. i have got my wrist plastered and this is the 6th week, can my injury will get well in 6 weeks or i should continue for other 6weeks.
I am bothered because i m flying to Canada on student visa on 24 th august. And i m bothered that as a student i will face problem with the immigration officer due to this injury.
It will be kind if you help me with a good suggestions and tips to avoid this problems
Thank you
yours faithfully
Santosh Reddy
It is really hard to say a fracture has healed without x-rays. Scaphoid fractures potentially can heal in 6 weeks, but it can often take 12 or more. The surgeon usually checks serial x-rays and determines when it is safe to come out of a cast. The risks of nonunion or avascular necrosis are significant enough with these injuries that hand surgeons are usually very cautious.
Hello Dr.Davidgeier
Thank you for your quick response. I am going to take an x-ray tomorrow.
I have one doubt i.e , My surgeon made my thumb immobile and left other fingers free.
Does moving the other fingers by working on keyboard or holding some light objects will effect my scaphoid injury?
And i feel no presure while working with rest of fingers.
Moving the other fingers, assuming the cast is protective enough, is usually not a problem.
I am a teenager and fractured my scaphoid playing rugby. It is not displaced. After 4 weeks, the X-ray showed no signs of joining. I am desperate to play again. I would rather have a screw and bone graft if that will be faster. What do you think? Thank you, Sean
In general, it takes 8-12 weeks for a scaphoid fracture to heal. Nonoperative treatment usually helps most nondisplaced fractures heal, but surgery to place a screw can be a good option. It is hard to tell you more without being involved in your care, but your hand surgeon should be able to direct you further.