![]() ![]() What is the treatment for a scaphoid fracture? ![]() They will be able to advise whether and when further investigations are needed. You will usually be followed up by an orthopaedic surgeon in the outpatient clinic if a scaphoid fracture is diagnosed or suspected. There is currently some debate as to whether there is benefit of doing further investigations such as a CT or MRI scan earlier if a scaphoid fracture is suspected but has not shown up on the initial X-ray. A radionuclide bone scan is occasionally used as an alternative but this is used less often, as MRI and CT scans are more widely available and expose you to less radiation. If this is the case, a CT scan or MRI scan may be suggested to look for the fracture. Sometimes, at this time, it is still not clear whether you have had a scaphoid fracture. ![]() A repeat X-ray may be suggested after 10-14 days. So, if a scaphoid fracture is suspected but not confirmed on an initial X-ray, you will usually be treated as if you have a scaphoid fracture (see below). At this time, the healing process will have started in the bone, which will help the fracture site to show up. In some cases, a scaphoid fracture will not show up on an X-ray until around 10-14 days after the initial injury. However, about 2 in every 10 scaphoid fractures may not be seen on X-ray at first. Special scaphoid view X-rays taken with your hand and wrist in a certain position may help to show up a scaphoid fracture. This is because the scaphoid bone can 'hide' behind the other carpal bones on an X-ray. Standard X-rays may not pick up all scaphoid fractures. However, it is important to recognise and treat a scaphoid fracture as soon as possible because the complication of non-union (see below) is more likely if treatment is delayed. It can sometimes be quite difficult to diagnose a scaphoid fracture. Movement of your wrist in certain directions may also be painful if you have fractured your scaphoid. It is a depression in your skin on the back of your hand near to the base of your thumb. This is known as the anatomical snuffbox. Also, when they examine your wrist and hand, there is a specific point where you are likely to be tender if you have a scaphoid fracture. In cases where waiting two weeks in a splint may cause undue hardship, or if the x-rays remain negative but the clinical exam is still suspicious, more sophisticated (and expensive) imaging techniques may be utilized, such as CT scan, bone scan, or MRI.A doctor will usually suspect a scaphoid break (fracture) by the mechanism of the injury that has happened - for example, a fall on to an outstretched hand. The patient should be re-evaluated about two weeks later, and if findings are still suspicious for a scaphoid fracture, x-rays at that time will usually show the fracture due to changes in the bone at the edge of the fracture. A non-displaced scaphoid fracture could thus be incorrectly diagnosed as a “sprain” because the x-ray was “negative.” Therefore a patient who has significant tenderness directly over the scaphoid bone (which is located in the hollow at the thumb side of the wrist, or “snuffbox”) should be suspected of having a scaphoid fracture and be splinted. However, when the scaphoid fracture is not displaced, x-rays taken within the first week may not reveal the fracture. Scaphoid fracture is most commonly diagnosed by x-rays of the wrist. ![]()
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