Scaphoid fractures are very common yet can be difficult to diagnose. There can be pain without swelling or bruising and there will be no obvious deformity in the area of the fracture site and no problems with movement. Some patients may not even experience pain over the fracture site.
The scaphoid is located in the wrist and is one of the eight carpal bones. Its location means that out of all of the carpal bones it is the one most often fractured, particularly in young, active adults involved in sport.
How fractures occur
A scaphoid fracture usually occurs after a fall onto an outstretched hand and of course one’s instinct is to use a hand to stop oneself from falling, leaving the wrist particularly vulnerable. A scaphoid fracture can either be undisplaced, (the bone fragments do not separate), displaced (the fragments separate and move out of alignment) or a proximal pole fracture may occur (which refers to a particular part of the scaphoid bone that has been fractured).
The fact that these types of fractures are difficult to diagnose means a lot do go undetected. Early diagnosis and treatment is, however, essential because, if missed, it can cause significant problems in the future due to the bone failing to heal properly. This is call non-union. The bone tissue can die (avascular necrosis or Osteonecrosis), and eventually if left untreated osteoarthritis can develop and result in decreased range of movement in the wrist. If diagnosed is delayed, Consultants will usually recommend surgery to try to stabilise the bone and this can help prevent the onset of osteoarthritis. However, such surgery is invasive and can involve a bone graft.
If someone has sustained an injury to the wrist after falling onto an outstretched hand, the examining doctor should look for a scaphoid fracture immediately. Clinical examination is important to check for obvious signs of a fracture, but as not all scaphoid fractures present with these signs an x-ray should also routinely be taken. Unfortunately, scaphoid fractures do not always show up initially on x-ray and in these cases patients are often advised to wear a splint before being re-examined and further x-rays taken after a period of approximately 1-2 weeks, by which time any fracture should be visible. An MRI or bone scan may be offered instead of repeat x-rays and these would usually be done straight away instead of waiting for a period of 1-2 weeks. An MRI in particular can reveal a fracture that would not yet be visible on x-ray, though repeat x-rays remain the preferred approach by most doctors. An undisplaced fracture would normally be treated by immobilisation, but a displaced fracture or a fracture of the proximal pole will require surgery to increase the chance of the bone healing properly and to minimize the risk of avascular necrosis and arthritis occurring.
Late diagnosis of a scaphoid fracture
If you have suffered a scaphoid fracture and believe that this was not diagnosed early enough by your doctor, here at Metcalfes our specialist team of medical negligence lawyers have experience of dealing with these types of cases and have secured compensation in the past for clients where such a failure has occurred. If you would like some advice for you or a family member please contact us on 0117 239 8012 or email us by using the online contact form and we will be happy to discuss your potential claim with you.
For more information or to speak to one of our friendly team for your free initial consultation, please call 0117 239 8012 or complete our online enquiry form.
- Medcsape - Clinical Presentation
- National Centre for Biotechnology Information - Vascularized Bone Grafts and Their Applications in the Treatment of Carpal Pathology
- National Institute of Arthritis and Musculoskeletal and skin diseases – Questions and Answers about Osteonecrosis (avascular necrosis)
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