Houston Methodist. Leading Medicine

Wrist FAQ


I've heard doctors say we shouldn't rely on the Internet for medical information but sometimes it helps. I'll tell you my situation. I fell and injured my wrist and had an X-ray that showed a "crack" and "slight" shift of the scaphoid wrist bone. Suddenly, I'm scheduled for surgery to pin the bone. A quick search of the internet and I found some information that suggested all I needed was a cast. Long story short: I took myself to another surgeon who confirmed what I found. No surgery. End of story. Sometimes the Internet does make a difference!


In the case of a scaphoid fracture (the "crack") that may or may not be displaced (the slight "shift"), there are many gray areas making a true diagnosis difficult. 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. Some surgeons avoid the dilemma of labelling the problem as displaced or nondisplaced by using the terms stable and unstable to describe the fracture. In some studies, CT scans were added to traditional X-rays in hopes of increasing the accuracy of diagnosis. But cadaver studies showed diagnosis of scaphoid displacement using CT scans was inaccurate more often than not. There is a need for future research to create a consensus definition of scaphoid fracture displacement. In a recent review of this problem, surgeons from Columbia University Medical Center in New York City suggested that a minimally displaced fracture is still displaced and should not be labelled as nondisplaced. They recommend conservative treatment with cast immobilization (based on current consensus) when there is a less than one millimeter separation with no translation and no angulation. So yes, we agree with you! There is much available on the Internet to help educate us all. In the case of medical problems, it is always a good idea to confirm information found with your health care provider (e.g., primary care physician, orthopedic surgeon). This step is advised before making treatment decisions where there isn't general agreement on all aspects of a specific condition or situation such as you described. 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.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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