What's the standard treatment for a wrist fracture involving the scaphoid bone? I'm asking because that's what my 27-year-old son has been diagnosed with after taking a bad fall. He's too old for me (his mother) to tell him what to do but that doesn't mean I don't check out what's happening for my own piece of mind.
The scaphoid bone of the wrist is located on the thumbside of the hand just below the radius bone of the forearm. Because the bones of the wrist are wedged together, any displacement or shift in the position of one bone changes the anatomic alignment of the wrist. Pain, loss of motion, and loss of function are common symptoms that must be addressed.
It is known that a scaphoid bone that is fractured and displaced will not heal without proper re-alignment. And there is consensus (general agreement) that the best way to accomplish this is through open surgery. The fracture is reduced (bone ends put back together) and the bone is replaced where it belongs anatomically. Fixation is used (e.g., screws) to hold it all together until healing occurs.
There is also consensus that a nondisplaced scaphoid fracture does not require surgery but can heal with cast immobilization. Screw fixation can also be helpful in these cases. But the real question is how to accurately diagnose scaphoid fracture displacement. This must be done in order to determine the best treatment approach.
There is no consensus on a definition of a nondisplaced scaphoid fracture. That may be why this patient received the first diagnosis of a "slightly" displaced scaphoid fracture. There can be a slight change in the angle of the scaphoid bone after fracture. Does that qualify for a diagnosis of displacement?
Some experts have defined scaphoid displacement by measuring the angle between the scaphoid and lunate bones. The lunate is another bone in the first row of wrist bones just below the forearm. It rests next to the scaphoid bone so a change in the angle or gap between these two bones would signal a true displacement. But once again, there is no common agreement as to the degree of angle or amount of gap that qualifies for displacement versus nondisplacement.
Conservative treatment with cast immobilization is recommended (based on current consensus) when there is a less than one millimeter separation with no translation and no angulation. Surgical fixation is most likely advised in all other cases.
Eric Swart, MD, and Robert J. Strauch, MD. Diagnosis of Scaphoid Fracture Displacement. In The Journal of Hand Surgery. April 2013. Vol. 38A. No. 4. Pp. 784-787.
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