Carpal Bones

For a slide show, see below:

The scaphoid or navicular is an important bone in the wrist. There are 8 small bones arranged in 2 rows. The scaphoid is on the thumb side. When people fall with the wrist extended, one potential injury is fracture of the scaphoid. One of the difficulties can be diagnosis since the initial X-rays are sometimes normal.

Anatomical snuff box

Sometimes when the pain is in the area called the snuffbox, even with normal X-rays the wrist is splinted until repeat X-rays are done and a definitive diagnosis can be made.

Repeat X-rays are typically done 10-14 days after the injury.  Usually, the combination of examination and X-rays can determine with certainty if there is a fracture.  If there is still some question, the wrist is again X-rayed 2 weeks later or a bone scan (or MRI) is performed.  Sometimes a CT is also useful.

Scaphoid blood supply

The scaphoid is a bone with a well-deserved reputation for being a trouble maker.  It sometimes does not like to heal!  This is partially a result of the blood supply being insufficient for the lower or proximal part of the bone.  This is the main reason that the wrist is splinted even when the diagnosis is uncertain.  Treatment needs to start right away and even a delay of a couple of weeks can prevent it from healing.

Scaphoid with proximal pole fracture

Surgery is recommend in many situations.  It is recommended if the fracture is displaced (if the bone is NOT aligned). It is recommended if the fragment is small and the bottom or proximal part.  This consists of using a special screw that does not stick out since there are joints all around.  It is placed entirely within the bone.

Great effort is make to get this bone to heal since left untreated, it will invariably lead to arthritis.  There are times when it is not fixed.  This can include a very late diagnosis when the wrist already shows some signs of arthritis.

When this happens, other surgeries are recommended – depending on the patient and the problem.  The slide show that follows shows some of these more unusual treatments that are described as salvage surgeries for the painful wrist.