The scaphoid is one of the small bones of the wrist and its fracture is the most common type of fracture in the wrist (90%), while it constitutes about 5% of fractures of the entire skeleton. The most common mechanism of injury is the patient falling to the ground with support on the affected hand (hyperextension of the wrist), while less often it can be a violent deviation of the tibiocarpal joint. It occurs at any age and is common in athletes and motorcyclists.
The scaphoid is one of the 8 bones we have in our wrist. These bones are arranged in 2 rows – verses, the proximal and the distal. The scaphoid has the peculiarity of belonging to both verses, which makes it valuable and irreplaceable in the function of the wrist.
After the injury, the fracture presents with pain and swelling on the radial side of the fibula, in the area near the base of the thumb. The injury is recognized by the point of intense sensitivity in the “anatomical snuff box”, a characteristic area of the wrist. In such a fracture, movements of the wrist, even the simplest, are painful, which betrays an injured joint.
Plain x-ray examination is particularly useful, but sometimes the scaphoid fracture is not always visible on a simple x-ray, so a CT or MRI may be requested to make the diagnosis definitively.
The symptoms of a scaphoid fracture, as we mentioned earlier, include:
- wrist pain,
- swelling in the wrist and especially at the base of the thumb,
- pain and difficulty in wrist and thumb movements when the person tries to grasp something.
Fracture repair depends on several factors. The scaphoid shows a peculiarity regarding its blood supply. The vascular branches that irrigate it, enter it from its periphery and blood the bone in reverse, that is, from the peripheral pole to the proximal one. This has the effect of disrupting the blood supply of its central part, when there is a fracture. Also, due to the presence of cartilage on 80% of the bone’s surface, fracture healing becomes even more difficult.
The above reasons are also the ones that create some concerns regarding the correct treatment of a scaphoid fracture. But the most basic criterion is the point of the fracture, whether it is simple or crushing and whether there is a small or large displacement.
In cases of non-displaced fractures, a splint/plaster covering the thumb and wrist is applied, which completely immobilizes the joint for about 6 weeks, while for displaced fractures, surgery is performed and then a cast is applied.
Physiotherapy begins immediately after the removal of the plaster, where from the very first day the gentle mobilization of the hand begins, which is combined with the use of physical means, such as ultrasound, electrotherapy, laser, ice therapy and with anti-edematous massage to reduce the swelling. Also, special mobilization techniques (Manual Therapy) are applied, with the aim of increasing the range of motion of the wrist and reducing pain. It therefore follows that physical therapy after a scaphoid fracture is considered necessary and, if done systematically, has excellent results in the rehabilitation of the upper limb and the hand.
