University of North Carolina’s Kendall Marshall will have surgery to fix a fractured scaphoid bone. Surgery is scheduled for sometime today, and will involve putting a screw in the scaphoid bone, according to Kendall’s father, Dennis Marshall.
In this article I’ll show you a picture of where the scaphoid is in the wrist, and what a typical screw looks like that might be put inside the bone in surgery.
Where is the scaphoid bone?
The scaphoid is a kind of smushed kidney bean-shaped bone that sits between the radius (large forearm bone) and the thumb – on the thumb side of the wrist.
Here’s an x-ray with a yellow circle around the scaphoid.
You can feel your scaphoid by pressing in this area of the thumb side of your wrist in an area called the anatomic snuffbox.
How does the scaphoid break?
Here’s a link to the video of Kendall’s injury. I can’t tell for sure but it looks like he has his hand underneath him as he falls.
The scaphoid bone breaks during a hyperextension injury of the wrist, when the wrist is bent backwards forcefully – usually in a fall.
The bone snaps in half, and the pieces either shatter or break cleanly.
How are scaphoid fractures treated?
A scaphoid fracture is very challenging to treat.
Scaphoid fractures are sometimes missed by doctors who see the x-rays. If they aren’t treated the right way by a hand and wrist surgeon (an orthopedic surgeon), they often heal wrong and lead to arthritis in the wrist.
Treatment is either surgical or non-surgical.
Which one is correct depends on whether the scaphoid is shattered, cleanly broken, and whether the pieces are lined up perfectly or not.
Scaphoid fractures can be treated in a cast, called a thumb spica cast. It looks like a regular fiberglass, hard cast, but has an extension that goes up around the thumb.
Here’s a picture.
In the right kind of cast, a scaphoid fracture can heal in 8 weeks. During this time, it’s dangerous to use the hand and wrist because the scaphoid won’t heal right if the pieces are moving against each other inside the wrist.
Scaphoid fractures usually heal if the patient is in a cast, avoids lifting or falling on the wrist, and avoids using the hand for the entire 8 week healing time.
Scaphoid fracture surgery usually involves putting pins or a screw inside the bone, across the pieces to stabilize the broken fragments (prevent them from moving).
This keeps them from moving while the pieces heal.
The healing process takes 6-8 weeks, but may take as long as 3 months.
A screw can be put in through a small incision if the pieces are lined up perfectly.
If the fracture is very stable with the screw inside, the patient can start moving the wrist in therapy and can even play sports wearing the right kind of protective splint.
Whether a player can or will play depends on several factors:
- pain level
- incision healing
- stability of the fracture
- motivation/risk tolerance of the player
- risk tolerance of the patient’s family
Risks of playing with a repaired scaphoid bone
- busting open the incision during a fall
- breaking the screw
- re-breaking the scaphoid bone
- causing more pain during a fall
The first three would require more surgery.
What will Kendall Marshall do?
I’m just speculating here, but after surgery, he’ll have a long and frank discussion with his family, coaches, and surgeon about the risks, pros, and cons that go along with playing after such a surgery.
Certainly if he plays with a splint or cast on his non-shooting hand and wrist, this would be safer than if he was trying to play after surgery on his shooting, dominant hand.
Tim Payne says
You Rock Doc. Great read t Payne RT(R)
Excellent review of a commonly fractured carpal bone. This is very reassuring information for the Tar Heel fan base that Kendall doesn’t have a career or season ending injury. We wish him a speedy recovery and a national championship! Thanks for the article and GO HEELS!
Paul Skinner says
3 weeks ago I had a bad fall at work. My wrist immediately swelled up and movement was very painful. I went right to emerg at hospital where they took exrays and casted wrist right away. They said they could not see the break but suspected it was broken. Could weeks later I had more exrays done and a new more accurate cast put on, but they still can’t see the break on exrays. The swelling has gone down but wrist is still painful. One orthopedic says leave cast on for 10 weeks and another orthopedic says put screws in bone. I’m confussed, if they can’t even see a break. ?
Advise and opinions are very welcome.
C. Noel Henley, MD says
You need to see a surgeon who specializes in hand and wrist injuries.
If they suspect a scaphoid fracture but aren’t sure, an MRI can help diagnose the injury.