Advertisement

Scaphoid fractures in the athlete

  • Mark J. Winston
  • Andrew J. Weiland
Hand and Wrist Sports Medicine (E Tolo and L Dwyer, section editors)
Part of the following topical collections:
  1. Topical Collection on Hand and Wrist Sports Medicine

Abstract

Scaphoid fractures are a common wrist injury, especially in athletes. Clinicians should have a high index of suspicion for a scaphoid fracture in any patient complaining of radial-sided wrist pain after a fall on an outstretched hand. Advanced imaging, including CT and MRI scans, may be useful in diagnosis and classification of fracture patterns. Treatment varies based on the fracture location, stability of the fracture, and predictability of the fracture to heal. Treatment involves either non-operative management with a thumb spica cast or brace, or operative fixation with a headless compression screw, k-wires, or scaphoid-specific plates. Return to play is dependent on many variables, including sport, fracture union, and ability to play with cast.

Keywords

Scaphoid fracture Athlete 

Notes

Compliance with ethical standards

Conflict of interest

Mark J. Winston declares that he has no conflict of interest.

Andrew J. Weiland reports personal fees from Medartis and Arthrex, outside of the submitted work.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Geissler WB, Slade JF. Fractures of the carpal bones. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s Operative Hand Surgery, Sixth ed. Elsevier; 2011.Google Scholar
  2. 2.
    Wolf JM, Dawson L, Mountcastle SB, et al. The incidence of scaphoid fracture in a military population. Injury. 2009;40:1316–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Rettig AC, Ryan RO, Stone JS. Epidemiology of hand injuries in sports. In: Strickland JW, Rettig AC, editors. Hand injuries in athletes. Philadelphia: WB Saunders; 1992. p. 37–48.Google Scholar
  4. 4.
    Weber ER, Chao EY. An experimental approach to the mechanism of scaphoid waist fracture. J Hand Surg [Am]. 1978;3:142–8.CrossRefGoogle Scholar
  5. 5.
    Horii E, Nakamura R, Watanabe K, et al. Scaphoid fracture as a puncher’s fracture. J Orthop Trauma. 1994;8:107–10.CrossRefPubMedGoogle Scholar
  6. 6.
    • Patel NK, Davies N, Mriza Z, Watson M. Cost and clinical effectiveness of MRI in occult scaphoid fractures: a randomized controlled trial. Emerg Med J. 2013;30(3):202–7. Looked at patients with suspected scaphoid injuries. Half of patients were treated with thump spica casting and repeat X-rays 2 weeks later. The other half of the study population received immediate MRI. If MRI was negative, the patient was discharged with no follow-up. Early MRI group had cost savings compared to control group given avoidance of cast fees and fewer clinic appointments. They also had earlier return to work and sporting activities. Google Scholar
  7. 7.
    Cooney III WP, Dobyns JH, Linscheid RL. Nonunion of the scaphoid: analysis of the results from bone grafting. J Hand Surg [Am]. 1980;5(4):343–54.CrossRefGoogle Scholar
  8. 8.
    Linscheid RL, Dobyns JH, Beabout JW, et al. Traumatic instability of the wrist: diagnosis, classification, and pathomechanics. J Bone Joint Surg Am. 2002;84-A(1):142.CrossRefPubMedGoogle Scholar
  9. 9.
    Russe O. Fracture of the carpal navicular. Diagnosis, non-operative treatment, and operative treatment. J Bone Joint Surg Am. 1960;42-A:759–68.CrossRefPubMedGoogle Scholar
  10. 10.
    Amadio PC, Berquist TH, Smith DK, Ilstrup DM, Cooney III WP, Linscheid RL. Scaphoid malunion. J Hand Surg [Am]. 1989;14:679–87.CrossRefGoogle Scholar
  11. 11.
    Adams BD, Blair WF, Reagan DS, et al. Technical factors related to Herbert screw fixation. J Hand Surg (Am). 1988;13:893–9.CrossRefGoogle Scholar
  12. 12.
    Amadio PC, Berquist TH, Smith DK, et al. Scaphoid malunion. J Hand Surg Am. 1989;14:679–87.CrossRefPubMedGoogle Scholar
  13. 13.
    Berger RA. The anatomy of the scaphoid. Hand Clin. 2001;17:525–32.PubMedGoogle Scholar
  14. 14.
    Gelberman RH, Menon J. The vascularity of the scaphoid bone. J Hand Surg [Am]. 1980;5:508–13.CrossRefGoogle Scholar
  15. 15.
    Gelberman RH, Wolock BS, Siegel DB. Fractures and non-unions of the carpal scaphoid. J Bone Joint Surg Am. 1989;71:1560–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Herbert TH. The fracture scaphoid. St Louis: Quality Medical Publishing; 1990.Google Scholar
  17. 17.
    • Everding NG, Evans PJ. Scaphoid Fractures in the Athlete: Acute and Chronic. The Athlete’s Hand and Wrist: A Master Skills Publication. Chapter 13. Chicago: American Society for Surgery of the Hand; 2014. Comprehensive text for evaluation and treatment of all common injuries seen in athletes.Google Scholar
  18. 18.
    Haisman JM, Rohde RS, Weiland AJ. Acute fractures of the scaphoid. An instructional course lecture. J Bone Joint Surg. 2006;88-A(12).Google Scholar
  19. 19.
    Dias JJ, Taylor M, Thompson J, et al. Radiographic signs of union of scaphoid fractures. An analysis of inter-observer agreement and reproducibility. J Bone Joint Surg Br. 1988;70:299–301.CrossRefPubMedGoogle Scholar
  20. 20.
    Richards RS, Roth JH. Common wrist injuries. In: Chan KM, editor. Sports Injuries of the Hand and Upper Extremity. New York: Churchill Livingstone; 1995. p. 214–5.Google Scholar
  21. 21.
    Dias JJ, Dhukaram V, Abhinav A, et al. Clinical and radiological outcome of cast immobilization versus surgical treatment of acute scaphoid fractures at a mean follow up of 93 months. J Bone Joint Surg (Br). 2008;90(7):899–905.CrossRefGoogle Scholar
  22. 22.
    Dias JJ, Brenkel IJ, Finlay DB. Patterns of union in fractures of the waist of the scaphoid. J Bone Joint Surg (Br). 1989;71(2):307–10.Google Scholar
  23. 23.
    Ford DJ, Kjoury G, el-Hadidi S, et al. The Herbert screw for fractures of the scaphoid. A review of results and technical difficulties. J Bone Joint Surg (Br). 1987;69(1):124–7.Google Scholar
  24. 24.
    Doornberg JN, Buijze GA, Ham SJ, et al. Nonoperative treatment for acute scaphoid fractures: a systematic review and meta-analysis of randomized controlled trials. J Trauma. 2011;71(4):1073–81.CrossRefPubMedGoogle Scholar
  25. 25.
    • Bond CD, Shin AY, McBride MR, et al. Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures. J Bone Joint Surg Am. 2001;83-A(4):483–8. Study compared scaphoid fractures treated nonoperatively and operatively in military recruits, which closely resembles an athlete with return to play.CrossRefPubMedGoogle Scholar
  26. 26.
    Cooney WP, Dobyns JG, Linscheid RL. Fractures of the scaphoid: a rational approach to management. Clin Orthop. 1980;149:90–7.Google Scholar
  27. 27.
    McCallister MV, Knight J, Kaliappan R, Trumble TE. Central placement of the screw in simulated fractures of the scaphoid waist: a biomechanical study. J Bone Joint Surg Am. 2003;85(1):72–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Rettig AC, Weidenbener DJ, Gloyeske R. Alternative management of midthird scaphoid fractures in the athlete. Am J Sport Med. 1994;22(5):711–4.CrossRefGoogle Scholar
  29. 29.
    Rettig AC, Kollias SC. Internal fixation of acute stable scaphoid fractures in the athlete. Am J Sport Med. 1996;24(2):182–6.CrossRefGoogle Scholar
  30. 30.
    Slade III JF, Gillon T. Retrospective review of 234 scaphoid fractures and nonunions treated with arthroscopy for union and complications. Scand J Surg. 2008;97(4):280–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Belsky MR, Leibman MI, Ruschelsman DE. Scaphoid fracture in the elite athlete. Hand Clin. 2012;28(3):269–78.CrossRefPubMedGoogle Scholar
  32. 32.
    Riester JN, Baker BE, Mosher JF, Lowe D. A review of scaphoid fracture healing in competitive athletes. Am J Sports Med. 1985;13(3):159–61.CrossRefPubMedGoogle Scholar
  33. 33.
    • Dy CJ, Khmelnitskaya E, Hearns KA, Carlson MG. Opinions regarding the management of hand and wrist injuries in elite athletes. Orthopedics. 2013;36(6):815–9. Includes surveys of surgeons taking care of professional athletes in different sports and preferences for return to play.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Hospital for Special SurgeryNew YorkUSA

Personalised recommendations