Therefore, even with a re-assuring X-ray, if a scaphoid fracture is suspected, then arrangements should be made to follow up the patient, either with a fracture clinic assessment, and/or a repeat X-ray. Whilst scaphoid fractures can be detected in an early X-ray, this is not always the case because the scaphoid bone can 'hide' behind the other carpal bones. The radiologist should specifically be instructed to X-ray the scaphoid bone. An examination of the wrist and hand should then be undertaken, followed by an X-ray. If a patient reports falling on an outstretched hand or experiencing a kickback injury, as described above, this should give rise to a suspicion of a possible scaphoid injury/fracture. There is a reasonable expectation that all clinicians working in emergency departments will be familiar with the mechanisms of injuries which might result in a scaphoid fracture and how to manage them.Ī key part of forming a diagnosis is ensuring that an appropriate history of the circumstances of the fall is taken and documented in the medical records. Consequently, fractures of the scaphoid bone are known to represent a relatively common diagnosis in day-to-day emergency department practice. Usually, patients will typically first present to the accident and emergency department with a possible scaphoid fracture because of the circumstances in which the injury was sustained and the severity of the symptoms experienced. The pain may be severe upon movement of the thumb or wrist, or when trying to pinch or grasp an object. The scaphoid bone plays an important role in both the motion and stability of the wrist joint and so prompt diagnosis of any injury to the bone and timely treatment is needed to ensure that a good recovery is made.Ī scaphoid fracture will usually result in immediate pain and swelling in what is known as the ‘anatomical snuffbox’ (located at the boundary of the thumb and wrist) and on the thumb side of the wrist. It is also known that scaphoid fractures can arise from what are termed ‘kickback’ injuries – for example, from a steering wheel in a car crash or when a football goalkeeper makes a save. Due to the mechanism of the injury, this form of fracture is often seen in patients who have sustained a fall when participating in sporting activities. The scaphoid bone resembles a boat with its relatively long, curved shape.Ī fracture of the scaphoid bone typically happens when a person falls onto an outstretched hand. The word ‘scaphoid’ comes from the Greek term for ‘boat’. Scaphoid fractures: what they are and the importance of early diagnosisĪ scaphoid fracture is a break in the wrist, and specifically, the small bone near the base of the thumb.
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