Fractures in people happen quite often. 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 scaphoid fracture. The ICD of the 10th revision assigned S62.0 to this damage. Its peculiarity lies in the fact that such a fracture is very difficult to identify. Inexperienced doctors often take damage for a banal injury, so treatment is prescribed incorrectly. In today's article, we will tell you what symptoms are accompanied by a scaphoid fracture. Also, the main methods of its treatment will be presented to your attention.
Anatomical reference
The scaphoid is considered one of the most traumatic elements of the wrist. It is located on the side of the thumb. The navicular formation owes its name to a shape resembling a boat. The wrist is represented by eight small bones that form two rows. Each of them has four elements. The scaphoid can be independently palpated in the area of the “anatomical snuff box”. This point is localized between the tendons of the thumb and the abducting muscle.
The anatomy of the joints and bones of the wrist is one of the most complex in the whole body. These structures allow you to make various movements in several planes. Ligaments, on the other hand, provide strength to joints. The scaphoid is responsible for the coordination of movements and the location of the remaining nearby structures. Therefore, with her fracture, the work of the entire wrist is disrupted.
Causes and mechanism of damage development
A scaphoid fracture most often occurs due to a fall on the arm. In this case, over-extension occurs in the area of the wrist joint. Therefore, the main part of the load falls on the scaphoid. In rare cases, traumatic injury is the result of a direct effect on this structure.
In the vast majority of victims, a closed scaphoid fracture is diagnosed. The presence of tears on the skin may be due to the characteristics of the injury. For example, when falling on a rocky surface.
Damage to the scaphoid is manifested in several ways. Among them, the main ones are as follows:
- The transverse split, which entails the formation of two equally sized fragments.
- Separation of bone along the edge.
- Fracture, accompanied by the formation of a large number of fragments and bone displacement. Otherwise, it is called multi-fragmented.
If we talk about the main causes of such injuries, most often they occur during sports or are a consequence of a car accident.
Clinical picture
Fracture of the scaphoid is difficult to diagnose. This is due to a mild clinical picture. Therefore, it is so important immediately after receiving an injury, seek the help of a doctor and undergo a comprehensive examination. This will help avoid future complications.
The main manifestations of a scaphoid fracture include:
- The appearance of swelling in the affected area. Over time, it can spread to larger areas.
- The presence of pain on the back of the wrist. Discomfort is usually aggravated by extension of the joint or pressure on the affected area.
- Violation of the full functioning of the hand.
- The presence of bruising and bruising due to rupture of blood vessels.
Symptoms that characterize a scaphoid fracture are diverse. With the correct diagnosis and competent physical examination, it is not difficult to suspect a problem.
First aid
After an injury, the victim must urgently provide first aid. First, the hand should try to immobilize. Extension or reflex muscle tension will provoke the displacement of bone fragments. They, in turn, can additionally injure soft tissues. You need to hang your hand on a scarf or piece of cloth in a free position. It is not recommended to fix the brush yourself with the help of a tire and bandages. Any treatment options without consulting a doctor are strictly contraindicated. Otherwise, you can only harm the victim, provoke the development of quite serious complications.
What can be done to relieve pain?
- Apply an ice pack to the affected area. Keep the cooling dressing for no more than 15 minutes so as not to cause frostbite. As a compress, you can use ice cubes, a bottle of cold water or a piece of frozen meat. Between him and the surface of the skin you need to lay a fabric. Non-sterile condensate must not be allowed to enter an open wound.
- Take a tablet of non-narcotic pain medication. In this case, you must follow the attached instructions and avoid overdoses. Otherwise, the medicine may cause poisoning.
Transportation of the victim is usually carried out on their own. If necessary, you can call a team of medical workers. In no case should you allow independent movement of a person to a car who suspects a scaphoid fracture. Severe pain causes a decrease in concentration.
Diagnostic Features
If one or more symptoms of injury appear, which were described just above, you should immediately seek qualified help. It is better to consult a traumatologist or surgeon.
The first step in the diagnosis is to collect an anamnesis. The patient should describe what preceded damage to the scaphoid. It can be a fall, intense sports or a domestic fight. Also, the doctor needs to know about previous diseases of the musculoskeletal system, injuries of the wrist joint.
After this, the specialist usually proceeds to a physical examination. With a fracture, a swelling is detected in the affected area, pain discomfort after palpation. Sometimes the patient is asked to bend the wrist joint, while paying attention to the features of movements in this area.
If the doctor suspects a scaphoid fracture of the arm, the patient is sent for radiography. The procedure must be carried out in three projections. The absence of obvious pathologies in the image does not mean at all that they are not in reality. In this case, the patient is given gypsum, which cannot be removed for two weeks.
After this period, repeated radiography is done. In 14 days, the bone will have time to go through the process of rarefaction, and the gap between the fragments will increase significantly. Such a fracture can be seen on a radiograph. Based on the results of the diagnosis, the doctor will be able to make an accurate diagnosis, give recommendations on treatment.
Conservative Therapies
Treatment for a scaphoid fracture depends on the severity of the injury and the level of activity of the victim. Not the last role in this matter is played by the patient’s desire to recover quickly.
In fracture without displacement, conservative methods of exposure are used. For treatment, gypsum is applied to the wrist joint and first finger. The bandage is worn for about two months, until the fracture is completely fused. Sometimes patients insist on surgery to reduce the period of immobilization and to quickly restore the efficiency of the hand. This method of treatment still causes controversy among surgeons.
A fracture of the lower third of the scaphoid fuses in 4-6 weeks. This part of the hand is characterized by good blood supply, so there are practically no problems with recovery.
Fracture in the middle third or in the proximal pole requires a longer treatment. These areas of the scaphoid have poor blood supply. The time of fusion largely depends on the age of the patient, metabolism. Periodically, you need to visit a doctor for an examination. In especially serious cases, step-by-step radiographs and CT scans may be required to assess the dynamics of recovery.
Regardless of the specific area of trauma, gypsum with a scaphoid fracture is applied to all patients. When wearing a bandage, doctors recommend:
- limit the mobility of the wrist;
- refuse to play sports;
- stick to a balanced diet;
- follow the regime of work and rest.
If you follow these recommendations, the healing process will go much faster.
Surgical intervention
With a pronounced displacement of fragments or a high risk of aseptic necrosis , surgical treatment is recommended for patients. Its main goal is the stabilization of the affected limb. This approach contributes to the speedy restoration of blood supply in the affected area, the healing of the fracture.
Surgical intervention is usually performed on an outpatient basis using regional or local anesthesia. During the operation, the doctor eliminates the displacement of bone fragments, fixes them with a screw (implant). To assess the result using an x-ray.
The incision is performed on the back or the palmar side of the wrist. Its size and specific location depend on how much of the scaphoid has been traumatized. Displacement is eliminated quite easily. A fresh fracture of the scaphoid of the wrist is usually fixed with a screw through an incision of about 3-5 mm.
If the damage has not grown correctly, a more serious approach is required. The surgeon first makes a large incision, allowing for an osteotomy. After that, he proceeds to recreate the correct anatomy, and then fixes the bone with screws.
When multiple lesions are present, a special transplant is used during surgery. It is a synthetic version of bone tissue. It is placed around the lesion. The graft is used to stimulate the healing process of tissues.
Recovery period
With a diagnosis of "scaphoid fracture", the timing of treatment largely depends on a well-organized rehabilitation. Recovery procedures begin with a course of exercise therapy. All exercises are selected by a specialist. Their main goal is the elimination of stiffness and contracture. The rehabilitation period can be divided into 3 conditional stages.
At the initial stage, exercise therapy pursues the following tasks:
- muscle relaxation in the affected area;
- elimination of pain;
- elimination of hemorrhage;
- normalization of lymphatic fluid circulation;
- recovery of metabolic processes.
These goals allow you to choose the most effective exercises. Typically, finger flexion and extension, circular and pendulum brush movements are used. This recovery phase lasts about 14 days.
From the third week, the exercises are slightly modified. Now LFK is aimed at restoring the functions of the limb and the range of motion of the joint. For this purpose, various complexes with a gymnastic ball and on a machine are recommended.
At the third stage, the tasks of exercise therapy are reduced to increasing the tone of the whole organism, improving the mood of the victim. Complicated exercises are allowed for patients: push-ups, pull-ups, etc.
After a scaphoid fracture and removal of the plaster cast, physiotherapy procedures (UHF, massage, paraffin baths) are mandatory. Properly selected rehabilitation methods can fully restore the mobility and performance of the damaged limb.
Possible consequences
Proper diagnosis of injury is very important, because it helps to prevent the development of negative consequences. In addition, a scaphoid fracture cannot be left without therapy. Untreated treatment threatens complications. Among them, the following are considered the most dangerous:
- Arthrosis of the wrist joint. Such a pathology is accompanied by excruciating pains and limitation of mobility in the limb. In especially serious cases, it leads to disability.
- Incorrect bone fusion. In rare cases, damaged fragments grow together at a slight angle. The patient at the same time experiences severe pain discomfort. A similar problem can only be solved with the help of a new operation. During surgery, repeated bone fracture is performed, alignment of all elements. After that, bone tissue transplantation is started.
- Necrosis. Against the background of poor blood supply, bone tissue begins to gradually die. As a result, an inflammatory process develops, and in advanced situations gangrene can occur. To eliminate this pathology often requires complete amputation of the hand. Aseptic form of necrosis develops gradually. At the initial stages, it is impossible to consider it even on a radiograph. 2-3 months after the injury, severe symptoms of the disorder appear. Very often it is no longer possible to save bone tissue.
To summarize
According to statistical information, a scaphoid fracture often goes unnoticed. Therefore, the appearance of various complications is inherent in this pathology. Timely diagnosis and competent therapy are the key to a successful recovery. At the same time, with the help of correctly carried out rehabilitation, it is possible to completely restore the functionality of the limb.
Doctors warn that a scaphoid fracture (ICD 10 - S62.0) is a very serious ailment. It should not be ignored and ignored. Damage to one small bone often results in disruption of the entire wrist.