Fracture of scaphoid bone: symptoms and treatment

Fractures in humans happen often enough. Usually injured limbs. Such fractures do not pose a threat to life. In most cases, their treatment and the subsequent recovery period are successful.

One of the most common types of injuries is a fracture of the scaphoid bone. The IBC of the 10th revision assigned this code S62.0. Its peculiarity is that it is very difficult to detect such a fracture. Inexperienced doctors often take damage for a banal bruise, therefore treatment is appointed incorrectly. In today's article, we will describe what symptoms are accompanied by a fracture of the scaphoid bone. Also, your attention will be presented to the main methods of its treatment.

Anatomic Help

Scaphoid bone is considered to be one of the most traumatic elements of the wrist. It is located on the side of the thumb. The name of the ship-shaped formation is due to a shape resembling a boat. The wrist is represented by eight small bones that form two rows. In each of them there are four elements. The scaphoid bone can be independently palpated in the area of the "anatomical snuff-box". This point is localized between the tendons of the thumb and the abduction muscle.

Anatomy of the joints and bones of the wrist is one of the most complex in the whole body. These structures allow you to perform various movements in several planes. On the other hand, the ligaments ensure the strength of the joints. The navicular bone is responsible for the coordination of movements and the location of the remaining nearby structures. Therefore, when it breaks, the work of the entire wrist is disrupted.

Causes and mechanism of development of damage

Fracture of the scaphoid bone most often occurs due to a fall in the arm. In this case, there is an over-extension in the wrist joint area. Therefore, the bulk of the load falls on the scaphoid bone. In rare cases, traumatic injury is the result of direct effects on this structure.

The overwhelming majority of victims are diagnosed with a closed fracture of the scaphoid bone. The presence of ruptures on the skin may be due to trauma features. For example, when falling on a stony surface.

Damage to the scaphoid bone is manifested in several variants. Among them the main are the following:

1. Cross-sectional split, which entails the formation of two identical in size fragments.
2. Tearing off the bone along the edge.
3. Fracture, accompanied by the formation of a large number of fragments and bone displacement. Otherwise it is called multi-lobed.

If to speak about the basic reasons of similar traumas, more often they arise at sports employment or are a consequence of automobile accident.

Clinical picture

A fracture of the scaphoid bone is difficult to diagnose. It is caused by a weak clinical picture. Therefore, it is so important immediately after getting injured to seek help from a doctor and undergo a comprehensive examination. This will help to avoid the development of complications in the future.

The main manifestations of a fracture of the scaphoid bone include:

1. Appearance of puffiness in the affected area. Over time, it can spread to larger areas.
2. The presence of pain on the back of the wrist. Discomfort usually increases with extension of the joint or pressure on the affected area.
3. Violation of the full functioning of the hand.
4. Presence of bruising and bruising due to vascular rupture.

Symptoms that characterize the fracture of the scaphoid bone of the hand are diverse. With proper diagnosis and competent physical examination, it is not difficult to suspect the problem.

First aid

After the injury, the victim must urgently provide first aid. First, the hand should try to immobilize. Extension or reflex muscle tension provokes displacement of bone fragments. They, in turn, can further injure soft tissues. It is necessary to hang your arm in a loose position on a scarf or a piece of cloth. It is not recommended to fix the brush independently with the help of tires and bandages. Any treatment options without consulting a doctor are strictly contraindicated. Otherwise, you can only harm the victim, provoke the development of serious enough complications.

What can be done to alleviate the pain?

• Apply an ice pack to the affected area. Keep the cooling bandage for no more than 15 minutes to avoid frostbite. As a compress you can use ice cubes, a bottle of cold water or a piece of frozen meat. Between it and the surface of the skin you need to lay a cloth. Do not allow non-sterile condensate to enter the open wound.
• Take a non-narcotic analgesic tablet. In this case, you must follow the attached instructions and do not allow overdoses. Otherwise, the medicine may cause poisoning.

Transportation of the victim is usually carried out on his own. If necessary, you can call a team of medical workers. In no case should you allow yourself to travel by car to a person who suspects a fracture of the scaphoid bone. A severe pain syndrome causes a decrease in concentration of attention.

Diagnostic Features

If you have one or more of the symptoms of trauma that were described just above, you should immediately seek qualified help. It is better to consult a traumatologist or surgeon.

The first stage of diagnosis is the collection of anamnesis. The patient should describe what preceded the damage to the scaphoid bone. It can be a fall, intense sports or a domestic fight. Also, the doctor needs to know about the previous illnesses of the motor apparatus, injuries of the wrist joint.

After this, the specialist usually passes to a physical examination. With a fracture, there is a swelling in the affected area, pain discomfort after palpation. Sometimes the patient is asked to bend the wrist joint, paying attention to the peculiarities of movements in this area.

If the doctor suspected a fracture of the scaphoid bone of the hand, the patient is sent for radiography. The procedure is mandatory in three projections. The absence of obvious pathologies in the image does not at all mean that they are not in fact. In this case, the patient is impregnated with plaster, which can not be removed for two weeks.

After this period, repeated radiography is done. Within 14 days the bone will have time to undergo the process of rasterification, and the gap between the fragments will increase significantly. Such a fracture can be seen on the roentgenogram. Based on the results of the diagnosis, the doctor will be able to make an accurate diagnosis, give recommendations for treatment.

Conservative methods of therapy

Treatment of the fracture of the scaphoid bone of the hand depends on the severity of the trauma and the level of activity of the victim. Not the last role in this matter is the desire of the patient to recover as soon as possible.

With a fracture without displacement, conservative methods of action are used. For treatment on the wrist joint and the first finger is impregnated with gypsum. The bandage is worn for about two months, until the fracture fully merges. Sometimes patients insist on conducting an operative intervention to reduce the period of immobilization and to restore the working capacity of the brush more quickly. This method of treatment still causes controversy among surgeons.

Fracture of the lower third of the scaphoid bone fuses in 4-6 weeks. This part of the brush is characterized by good blood supply, so there is practically no problem with recovery.

A fracture in the middle third or in the proximal pole requires a longer treatment. These areas of the scaphoid bone have poor blood supply. The time of adhesion depends largely on the patient's age, metabolism. Periodically it is necessary to visit a doctor for examination. In particularly serious cases, it may be necessary to take an X-ray and conduct CT to assess the dynamics of recovery.

Regardless of the specific area of trauma, gypsum in the case of a fracture of the scaphoid bone is imposed on all patients. When wearing bandages, doctors recommend:

• To limit the mobility of the wrist;
• To refuse to engage in sports;
• Adhere to a balanced diet;
• Follow the regime of work and rest.

ого быстрее. If these recommendations are followed, the process of recovery will be much quicker.

Surgical intervention

If there is a pronounced displacement of fragments or a high risk of aseptic necrosis, patients are advised to have an operative treatment. Its main goal is the stabilization of the affected limb. This approach contributes to the early restoration of blood supply in the affected area, fracture fusion.

Surgical intervention is usually performed on an outpatient basis using regional or local anesthesia. During the operation, the doctor removes the displacement of bone fragments, fixes them with a screw (implant). An X-ray is used to evaluate the result.

The incision is performed on the back or palmar side of the wrist. Its size and specific localization depend on which part of the scaphoid bone has been traumatized. Displacement is eliminated quite easily. A fresh fracture of the scaphoid bone of the wrist is usually fixed with a screw through a cut about 3-5 mm.

If the damage has grown together incorrectly, a more serious approach is required. The surgeon first makes a large incision allowing an osteotomy. After that, he begins to recreate the correct anatomy, and then fixes the bone with screws.

When multiple lesions are present, a special graft is used during the operation. It is a synthetic variant of bone tissue. It is placed around the lesion. The transplant is used to stimulate the process of tissue healing.

Recovery period

With the diagnosis of "fracture of the scaphoid bone of the hand," the timing of treatment largely depends on a well-organized rehabilitation. Restorative procedures begin with the course of exercise therapy. All exercises are selected by a specialist. Their main goal is to eliminate stiffness and contracture. The rehabilitation period can be divided into 3 conditional stages.

At the initial stage, the exercise therapy pursues the following tasks:

• Muscle relaxation in the affected area;
• Elimination of pain syndrome;
• Elimination of hemorrhage;
• Normalization of circulation of the lymphatic fluid;
• Restoration of metabolic processes.

These goals allow you to select the most effective exercises. As a rule, flexion and extension of fingers, circular and pendular movements by a brush are used. This recovery phase lasts about 14 days.

From the third week, the exercises are somewhat modified. Now LFK is aimed at restoring limb functions and the amplitude of joint movements. For this purpose, various complexes with gymnastic ball and on the machine are recommended.

At the third stage, exercise therapy tasks are reduced to increasing the tone of the whole body, improving the mood of the victim. Patients are allowed to do complicated exercises: push-ups, pull-ups and so on.

After the fracture of the scaphoid bone and the removal of the plaster bandage, physioprocedures (UHF, massage, paraffin applications) are mandatory. Correctly chosen methods of rehabilitation allow to completely restore mobility and efficiency of the damaged limb.

Possible consequences

Competent diagnosis of trauma is very important, because it helps to prevent the development of negative consequences. In addition, one can not leave a fracture of the scaphoid bone without therapy. Treatment, conducted untimely, threatens the appearance of complications. Among them, the most dangerous are the following:

1. Osteoarthritis of the wrist joint. This pathology is accompanied by painful pains and restriction of mobility in the limb. In particularly serious cases, it leads to disability.
2. Incorrect bone fusion. In rare cases, the damaged fragments coalesce at a small angle. The patient experiences severe pain discomfort. Such a problem can only be solved with the help of a new operation. During the surgical intervention, repeated bone scrapping, alignment of all elements is performed. After this, they begin to transplant the bone tissue.
3. Necrosis. Against the backdrop of poor blood supply, bone tissue begins to gradually die off. As a result, the inflammatory process develops, and gangrene may develop in neglected situations. To eliminate this pathology, a complete amputation of the wrist is often required. Aseptic form of necrosis develops gradually. At the initial stages it can not be considered even on the roentgenogram. 2-3 months after the injury, severe symptoms of the disorder appear. It is often not possible to save bone tissue.

Let's sum up the results

According to statistical information, the fracture of the navicular bone of the brush often goes unnoticed. Therefore, this pathology inherent in the emergence of various complications. Timely diagnosis and competent therapy are the key to successful recovery. Moreover, with the help of properly performed rehabilitation, it is possible to fully restore the functionality of the limb.

Doctors warn that a fracture of the scaphoid bone (ICD 10 - S62.0) is a very serious ailment. Leave it without attention and ignore its manifestations should not be. Damage to one small bone often results in a disruption to the entire wrist.