The scaphoid is a bone in the wrist that is the most frequently fractured of the carpal bones. Due to the anatomy of the blood supply to the bone, a fracture is capable of disrupting blood supply, resulting in necrosis or death of the bone. Orthopedists have proposed fracture classification systems based on fracture pattern and location; however, another classification that may better determine treatment is whether the fracture fragments are displaced or nondisplaced.
Nondisplaced, or Stable, Scaphoid Fractures
A nondisplaced or stable fracture does not have any shift in bone fragments. It is common for the initial x-ray on the day of injury to not even show a fracture line, according to a "American Family Physician" article by Dr. T. Grant Phillips. A CT scan or MRI can be used to find a fracture line and measure the amount of shift of the fragments. These nondisplaced fractures are typically treated nonoperatively, with a cast known as a long arm thumb-spica cast. This type of cast produces the least amount of scaphoid movement to optimize healing.
Displaced, or Unstable, Scaphoid Fractures
The definition of a displaced or unstable scaphoid fracture involves either a 1 mm or greater shift of the bone fragments, or a significant change in the angulation of the bone. The term "angulation" refers to the rotation of the fractured fragment. Nearly all displaced or unstable fracture fragments require surgery to improve healing outcomes. The specific surgery type and hardware used to perform the "fixation" depends on the individual fracture and the judgment of your orthopedic surgeon.
Scaphoid Fractures with Complications
Scaphoid fractures are notorious for not healing. Typically, fractures that are not treated within the first 28 days are at significantly higher risk for complications. These nontreated fractures can lead to various arthritic changes and the breakdown or collapse of bones, including the scaphoid itself, by avascular necrosis. Avascular necrosis refers to death of the bone due to lack of blood supply. This is due to the specific blood supply to the scaphoid, which is altered during most fractures.
Fractures with even minimal displacement are at greater risk for complications if not adequately and promptly treated by a qualified physician.
