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No Ordinary Break

This bone has the anatomic disadvantages of having poor blood supply, as well as being nestled within the wrist.  When injured, this can feel like a simple wrist sprain.  If the pain does not quickly resolve, then there may be a concern for a scaphoid fracture.

scaphoidAssuming you already know the basic anatomy of the wrist, we will jump ahead to one specific bone that sits at the base of the thumb and the forearm- the scaphoid, or sometimes called navicular bone. This bone is the most frequently fractured carpal bone.  Injuries to the scaphoid commonly occur with falling on an outstretched hand, or jamming the wrist during a high intensity activity.

These fractures, if left untreated, can have some profound effects on the structure of the wrist. When the scaphoid is fractured it typically breaks at the middle, or ‘the waist’. The scaphoid has one main artery supplying blood to the lower portion, so if the blood supply is interrupted, then nonunion can occur. This means the bone will either die (via necrosis), or wither up like a dissolving malted milk ball.

Kansas City Bone and Joint Wrist PainGiven the poor blood supply status of the scaphoid, healing is always a major factor. While in the healing phase, physicians will encourage tobacco cessation and sometimes even caffeine cessation. Nicotine is a stimulant which increases heart rate, raises blood pressure, and is a vasoconstrictor- which means it makes arteries in the body contract, thus allowing less blood flow through that area. Caffeine is also a vasoconstrictor but requires large volumes of caffeine to be detrimental to healing.

We know now that the scaphoid is a bad healer, so why don’t we just let it die and move on with life?

The wrist bones are precariously placed, much like marbles in a jar. If you take one marble out of the bottom the rest of the marbles with shift to fill that missing spot.  Should this occur in the wrist, bones will start to rub, wear, and grind unnaturally- causing an acceleration of arthritis which translates to pain and loss of function.

thumb spica castIf a scaphoid fracture is caught early enough, proper treatments, such as immobilization, bones stimulator use, or surgical intervention can be done to aid in healing. Even then, these fractures are difficult to heal.  It is important to see an orthopedic surgeon for proper evaluation as these fractures are not easily diagnosed.

 

 

By Stephanie Jones

Sources: https://www.orthobullets.com/hand/6034/scaphoid-fracture

https://orthoinfo.aaos.org/en/diseases–conditions/scaphoid-fracture-of-the-wrist

http://www.assh.org/handcare/hand-arm-injuries/scaphoid-fracture https://www.ncbi.nlm.nih.gov/pubmed/1323208

https://www.ncbi.nlm.nih.gov/pubmed/19482261