Diagnosis of scaphoid fracture (scaphoid fracture)

 

What symptoms does a scaphoid fracture cause?

Sometimes the injured person feels a „crack“ in the thumb during the accident and has a feeling in the wrist that something is broken.

In many cases the wrist swells up and hurts a few hours after the accident. Sometimes a bruise (haematoma) is seen on the wrist a few hours after the injury. The pain becomes worse when the thumb is grasped. The same is true when the wrist is strained.

The scale of pain intensity ranges from very little pain and almost no limitation of the load in the wrist to very strong pain and almost inability to use the wrist?

 

Is it possible to diagnose a scaphoid fracture yourself?

No! In the typical scaphoid fracture, pressure on the spoke-side wrist region can cause a strong pain when pressed.

A tip for self-diagnosis of a scaphoid fracture: Especially when the thumb is spread apart, a small depression can be seen at the root of the thumb. (Shown as a black line in the figure).

The doctor calls this indentation the tabatiere. The scaphoid lies under the tabatiere. A strong pressure pain in this area – after a fall on the hand – is suspicious of a scaphoid fracture.

This pressure pain is an indication of a scaphoid fracture, but is not yet a sure proof. Such symptoms also occur with a fracture of a spoke (radius fracture), a rupture of the ligament between the scaphoid bone and the lunate bone (S-L ligament) or with a severe sprain.

 

Therefore, an X-ray image is absolutely necessary to confirm the diagnosis of scaphoid fracture.

x-ray_scaphoid_fractuere

 

Yes, only an x-ray (or MRI or computer tomography) can reliably diagnose a scaphoid fracture!

 

The figure shows a typical situation:

The x-ray image taken the day after the fall shows the scaphoid fracture. However, the fracture line (arrows) in the scaphoid is not very conspicuous.

However, it must be emphasized that the absence of evidence of a scaphoid fracture in an x-ray image taken a few days after an accident does not allow to exclude a scaphoid fracture with certainty.

What should the doctor do if an X-ray of the wrist does not show a scaphoid fracture with certainty?

If there is a well-founded suspicion of a scaphoid fracture – e.g. severe pain, pronounced swelling, pain due to pressure over the scaphoid, violent fall – the doctor can either order a CT (computer tomography) of the wrist or immobilize the wrist in a plaster splint for about 10-14 days and then take another X-ray. In the case of a scaphoid fracture, this is usually visible on a conventional X-ray after about 14 days. 

 

Why no computer tomography as an immediate measure?

Computed tomography has a much higher radiation exposure than conventional x-rays of the wrist and, of course, even more so than an MRI that is free of X-rays. The various imaging procedures all have their advantages and disadvantages, which must be weighed up against each other in each individual case.

The CT (computed tomography) of the scaphoid is also ideal for monitoring the progress of poorly healing scaphoid fractures.

The figure shows a large gap in the scaphoid. The fracture has not yet healed despite 3 months of immobilization.

 

Why then no magnetic resonance tomography (MRT) ?

The CT image (computer tomography) is by far the best method to show the scaphoid in all layers and to diagnose or exclude a scaphoid fracture with certainty. The MRI image of the wrist (nuclear spin) can answer specific questions.

The MRI is particularly valuable on the scaphoid in the case of scaphoid fractures with a small fragment (small proximal fragment).

This small fragment may lack blood supply to the bone as a result of the accident. This is very important for the choice of a surgical procedure!

The figure shows a normal situation on the scaphoid bone as shown in the MRI. (All bones of the carpus are well supplied with blood.

 

What should be done if a scaphoid fracture is suspected?

It is essential to consult a physician experienced in hand surgery. Please do this in the first days after the accident. Overlooking or treating the scaphoid fracture too late can have considerable disadvantages for you.

 

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