bubble_chart Overview

The scaphoid is an important component of the wrist joint, articulating with the radius and carpal bones around it, with 80% of its surface covered by cartilage. Nutrient vessels enter from the waist and tubercle, with blood flow distributed from distal to proximal. A fracture at the waist can interrupt blood flow to the proximal segment.

bubble_chart Clinical Manifestations

Swelling and pain on the radial side of the wrist after injury, with increased pain and limited movement during wrist joint activity. There is obvious tenderness at the anatomical snuffbox and the scaphoid tubercle. Radial deviation of the wrist joint, and pain at the fracture site upon percussion or compression along the long axis of the first and second metacarpals.

X-rays should include anteroposterior, lateral, and scaphoid views of the wrist joint, which can usually reveal the fracture line. Sometimes, in cases of non-displaced fractures, early X-rays may appear negative. For suspected cases, a follow-up X-ray should be taken two weeks later, as bone resorption at the fracture site post-injury can widen the fracture line and make it visible. In old fractures, the fracture line may appear significantly widened, with sclerosis or cystic changes at the fracture ends, indicating non-union. If the density of the proximal bone fragment increases or deforms, it suggests avascular necrosis.

bubble_chart Treatment Measures

1. For a fresh fracture, the forearm should be immobilized in a functional position using a gypsum cast. The gypsum cast should extend from below the elbow to the distal palmar crease, including the proximal phalanx of the thumb. During the immobilization period, finger functional exercises should be consistently performed to prevent joint stiffness. For fractures at the tuberosity, immobilization is required for 4-6 weeks; for fractures at the waist or proximal area, immobilization is needed for 3-4 months, sometimes even half a year or a year. Regular radiographic examinations should be conducted every 2-3 months, and immobilization should continue until bone healing is achieved.

For patients clinically suspected of having a fracture but with negative X-ray findings, initial immobilization with a gypsum cast is recommended. The gypsum cast should be removed after 2 weeks for a follow-up radiographic examination. If a fracture is confirmed, immobilization should be continued.

2. For old fractures with no symptoms or mild symptoms, treatment may not be necessary. Simply reduce the activity level of the wrist joint and continue follow-up observation. For patients with significant symptoms, if no ischemic necrosis or nonunion is found, a trial of gypsum immobilization may be considered, often requiring 6-12 months to achieve bone healing. For cases where nonunion or ischemic necrosis has already occurred, treatment options such as radial periosteal bone flap transfer, drilling and bone grafting, proximal bone fragment resection, or radial styloidectomy may be considered based on the specific situation. For severe traumatic arthritis of the wrist joint, wrist arthrodesis may be performed.