What I now know about scaphoid fractures

Yep, that’s right I broke my scaphoid. I was commuting to work on my bike (pedal not motor) in June and a car turned towards me. I crashed but didn’t get hit by the car; I still say it was the best possible option. So after walking around for a couple days in a lot of pain I finally went to the hospital. They x-rayed my entire left side and the only thing that came back was a possible fracture of my scaphoid.

The scaphoid is one of the many small bones in your wrist. If you make a thumbs up there is a hollow at the base of your thumb, that is where the scaphoid lives. Half of the scaphoid, the half closer to your thumb, heals nicely. But if you break it at the waist (the middle point) or the end closer to your forearm (the proximal pole) healing is more sporadic. The problem is that there is no blood delivered directly to the proximal half, no blood means no healing. The blood has to basically percolate through from the other end, a task that is particularly challenging if there is a fracture.

Okay, so no blood flow and no healing means that the bone can die, and if it dies it will significantly impact your wrist mobility. Consequently, they put you in a cast if they think the scaphoid might be broken.

So my x-rays showed a possible fracture so they casted me and sent me to the specialist. Enter problem number two – the scaphoid is notoriously difficult to see on x-rays. You have to do a special set of x-rays to even have a hope and even then there is some question. As long as there is question you are kept in a cast and typically sent for further tests.

Enter the MRI, now here it was a bit weird because the doctor requested a CT scan and I got an MRI, nobody understands. The CT scan is better at showing bone but the MRI should catch it. Mine did not. So the surgeon took me out of the cast and okayed my trip to Europe without cast. By the way, I was playing clarinet in Europe, good thing that doesn’t require your wrist at all (just a small note of sarcasm).

When I got back, the surgeon decided it was broken. (It has been a month and a half at this point.) So I was in a splint, non stop for four weeks. Still broken. Surgery was next. They made what seems like a huge incision, moved all my soft tissue out of the way, and stuck a screw in my scaphoid. Seven weeks of cast later and it has finally healed. Now begins the rehab.

The most common way of breaking your scaphoid is to fall on outstretched hand or FOOSH. The most common people this effects are men about 18-30 years of age, presumably because they are the ones doing the activities that you are most likely to fall on your wrists in. And generally speaking I was the only woman in the hospital rooms who had the scaphoid, there was usually a guy or two so it matches my experience.

Here is my advice – I am quite happy with my medical care, but it helped that I did a bunch of research on scaphoid fractures. I understood the challenges in diagnosis and healing. I also understood what the surgeon was saying when he talked to his entourage (the group of fellow doctors, residents, and medical students who seem to travel with him). But if you FOOSH and the pain doesn’t go away, go get it checked out. It wasn’t until about a week after my fall that the pain moved into my wrist. If you had asked me at the time, I would have sworn it was actually my elbow I broke.