The scaphoid is the most frequently fractured carpal bone in the wrist. This fracture is often the result of a fall from ground level with the wrist hyperextended and turned towards the thumb (radially deviated).
In lower energy injuries, patients with a scaphoid fracture may have minimal discomfort with no swelling. Furthermore, the fracture of the scaphoid when initially undisplaced is often times not visible on a plain x-ray. In this low energy presentation, the fracture is often misdiagnosed as a wrist sprain unless a high index of suspicion is present by the clinician. If a scaphoid fracture is missed and the wrist is not immobilized, a nonunion will develop, which is difficult to treat.
In higher energy injuries, such as a fall from a height, a sports injury, or a motor vehicle accident, the fracture and ligamentous injuries are more obvious. Patients with a scaphoid fracture may complain of thumb sided wrist pain, decreased range of motion of the wrist, swelling and weakness and on exam will demonstrate tenderness in an area of the wrist called the “snuff box”.
The scaphoid receives little blood supply and often fails to heal in 13- 50% of fractures. This percentage increases in fractures of the scaphoid involving the proximal pole. Due to the limited blood supply, scaphoid fractures have a prolonged healing time, ranging from nine months to one year for confirmed healing.
When a scaphoid fracture does not heal, it will progress to scaphoid collapse and progressive wrist arthritis. Treating a scaphoid fracture that doesn’t heal is very challenging and therefore an accurate diagnosis and timely treatment is preferable.