The scaphoid bone spans across the two rows of bones that make up your wrist. If broken, it rarely swells and if it does, it goes down within a few days, so it is often missed and put down to a sprain rather than a break. A missed scaphoid fracture can have long term effects and can lead to arthritis or lack of mobility.
Symptoms and Treatment
Due to the location of the scaphoid, it is the most commonly broken bone in the wrist when someone falls on an outstretched hand.
The fracture causes tenderness directly over the bone and the pain may increase when you move your thumb or grip something. It rarely causes bruising or swelling. The initial pain may decline within a few days or weeks.
Scaphoid fractures can be identified on x-rays, but due to the location, very specific positioning is required to ensure the x-ray shows the fracture. Medical professionals should assume that anyone who has fallen onto their wrist with slight pain or swelling may have a scaphoid fracture and should take the necessary steps to rule it out.
Initial x-rays don’t always show a fracture, so if there is any suspicion, the wrist should be immobilised in a splint and scheduled for additional x-rays. The gap of the fracture will often have widened enough within a couple of weeks making it easier to identify by x-ray. If there is still a suspicion of a scaphoid fracture that isn’t visible by x-rays, MRI and CT scans can be used.
Treatment depends on the location of the fracture. Fractures located near the thumb can heal with a cast to hold the bone in place while it heals. Fractures with a poor blood supply or when the bone fragments need to be manipulated or reduced require surgery and held in place with a pin.
Missed Scaphoid Fracture
The lack of swelling or deformity of the wrist means that diagnosis of a scaphoid fracture can be delayed by weeks, months or even years.
There are occasions when scaphoid fractures are spotted on an x-ray but the patient can’t remember injuring their wrist as the symptoms can be so subtle.
Some scaphoid fractures will heal naturally, but in most cases the fracture fails to heal. The scaphoid then develops what surgeons call a non-union or the more serious avascular necrosis.
- Non Union Scaphoid Bone: This occur when the two pieces of bone fail to heal together. The symptoms are more subtle and can go missed for months, leading to a gradual increase in pain and the risk of degenerative arthritis in the wrist joint.
- Avascular (no blood supply) Necrosis (dead) Scaphoid. This occurs if the fracture tears the small artery in the bone, this restricts the blood supply to the bone and consequently the thumb at the end of the bone, leading to the bone tissues dying. The symptoms of avascular necrosis become much easier to see several months after the injury.
Even if a scaphoid fracture is identified early enough for a cast or surgery, there is no guarantee it will heal normally and may still develop into a non-union.
Scaphoid Fracture Claims
Pryers Solicitors help many clients who have received substandard or negligent medical care, including those who have suffered from a missed scaphoid fracture. Due to the subtle symptoms a missed scaphoid fracture might not always be negligent. However, if you have fallen on an outstretched hand, your healthcare professional should give you a physical examination and take specific x-rays targeted at the scaphoid bone and provide you with follow up imaging and CT or MRI scans around two weeks after the injury.
The consequences of a missed scaphoid fracture can have long term effects, leading to arthritis and lack of mobility. If you think you have suffered as a result of a missed scaphoid fracture speak to our experts today.
We have previously helped clients to recover compensation where a 15 month delay in diagnosis resulted in reduced movement, continued pain and an unnecessary operation and where poor x-rays resulted in a skier suffering with a permanent disability.