injuries and poisoning
Wrist Fractures
Scaphoid Fractures
Scaphoid fractures involve a bone in the wrist near the base of the thumb (scaphoid bone). Scaphoid fractures usually result from a fall on an outstretched hand. These fractures can disrupt blood flow to the scaphoid bone, causing osteoarthritis and loss of function. The thumb side of the wrist is tender and swollen, and rotating the wrist is particularly painful. X-rays are taken, but because scaphoid fractures may be hard to see soon after the injury, other imaging tests may be needed, or a splint may be placed and x-rays repeated after 7 to 10 days. A thumb spica splint is often effective, but sometimes surgery is needed to put the broken pieces of bone in place and hold them in place. The scaphoid bone is the most commonly injured of the eight wrist (carpal) bones, located between the bones of the forearm and those of the hand. Scaphoid fractures usually result from a fall on an outstretched hand. These fractures often cause problems because they often disrupt the blood supply to the scaphoid bone. Without its blood supply, the following may occur: The bone may not heal and may then deteriorate and collapse. Tissue may die (called Osteonecrosis ), resulting in osteoarthritis and disability. The bones may not grow back together (called nonunion). These problems occur in about 5 to 10% of people and can occur even when treatment is optimal. The thumb side of the wrist is tender and swollen in people with a scaphoid fracture. Rotating the wrist is particularly painful. A doctor's evaluation X-rays Sometimes magnetic resonance imaging If people think they may have fractured their wrist, they should see a doctor. Doctors suspect a scaphoid fracture based on symptoms and results of a physical examination. X-rays are taken, but these fractures may be hard to see soon after the injury. If x-rays do not show a fracture but the physical examination suggests a fracture, most doctors apply a splint. People are asked to return in 7 to 10 days for another x-ray to check for a fracture. (Fractures may be seen more easily after they have been healing for a few days—see How bones heal .) Magnetic resonance imaging (MRI) can be done to check for a fracture when none is seen on a x-ray. However, it is expensive and not always available. A thumb spica splint Sometimes surgery After diagnosis is confirmed, many scaphoid fractures can be effectively treated with a thumb spica splint that is worn for up to 6 to 8 weeks. Sometimes surgery ( Surgery , or ORIF) is required to realign and immobilize the broken pieces. The bone may take 3 to 4 months to heal. 