Overview

What is a navicular fracture of the wrist?

A navicular fracture (also called a scaphoid fracture) is a break in a small bone on the thumb side of your wrist. Of the eight carpal bones in your wrist, your navicular bone is the most likely one to break.

It is important to find out if you have a navicular fracture, because navicular fractures need treatment to heal well. With proper treatment and follow-up, most navicular fractures will heal over time. Without treatment, and sometimes with treatment, healing can be slow and difficult because parts of the navicular bone don't have a good blood supply. If your navicular bone does not heal well, you can have long-term pain, stiffness, or arthritis in your wrist.

What causes a navicular fracture?

Most navicular fractures occur when you stretch your hand out in front of you to protect yourself from a fall. They can also occur when your wrist twists severely or is hit very hard. Navicular fractures often happen while a person is playing sports such as football, soccer, or basketball or during activities such as in-line skating, skateboarding, or bike riding. They can also occur as a result of a car crash or a fist fight.

What are the symptoms?

Because most navicular fractures do not cause the wrist to look broken and many cause only minor symptoms, it can be hard to know if your navicular bone is broken. If the bone is broken, you may have:

• Pain, tenderness, or swelling on the thumb side of your wrist.
• A hard time grabbing or gripping things or moving and twisting your wrist or thumb.
• Bruises around your wrist.

It can be hard to tell the difference between a wrist that is sprained and one that is broken. If you have fallen on an outstretched hand and your wrist hurts, be sure to see a doctor to find out if you have any broken bones. Navicular fractures that are not treated properly can lead to long-term problems.

How is a navicular fracture diagnosed?

Your doctor will ask you questions about your symptoms and about how and when you hurt your wrist. He or she will then look at your wrist, find any swollen or tender areas, and see how well you are able to move your wrist and thumb. Your doctor will also try to find out how well blood is flowing to your hand and if you have any nerve damage in your wrist.

Most likely, your doctor will order X-rays of your wrist. Sometimes an X-ray clearly shows a navicular fracture. Other times, an X-ray may not show signs of a fracture. If your doctor is not sure if your wrist is broken, he or she may refer you to an orthopedic surgeon, a doctor who specializes in bone problems. Because fractures can't always be seen right away, you may need a follow-up X-ray in 1 to 2 weeks. In the meantime, to prevent possible long-term problems, you will be treated as if you do have a fracture.

In some cases, other imaging tests such as MRIs, CT scans, and bone scans are used to look for navicular fractures.

How is it treated?

Treatment for navicular fractures includes wearing an arm cast or splint and sometimes having surgery. Even if the first X-rays do not show a fracture, your doctor still may treat you to prevent possible problems with healing.

Right after the injury, you may wear a splint because your wrist is too swollen to put a cast on. You may also wear a splint if it is not clear whether your bone is broken. For the first few days, your doctor may tell you to keep your wrist higher than the level of your heart and to use cold packs or ice to reduce swelling. He or she may also prescribe a pain medicine or suggest a pain medicine that you can buy without a prescription, such as acetaminophen (for example, Tylenol) or ibuprofen (for example, Advil or Motrin). Be safe with medicines. Read and follow all instructions on the label.

In some cases, after the swelling is gone, the splint will be removed and a cast will be put on. The cast will enclose your thumb and may extend above your elbow. Some people only need to wear a cast for 6 weeks, while others may have to wear a cast for several months. How long your wrist takes to heal depends on how serious your fracture is. Regular visits to your doctor will help you to know how well your fracture is healing and learn how to care for your splint or cast.

In other cases, you may need surgery to put pieces of your bone in the proper place or to help your bone heal faster. You may also need surgery if part of your bone has died because it did not get enough blood. If you have surgery, you will need to wear a splint or cast afterward.

Once a splint or cast is removed, your arm or wrist may feel weak or stiff. Your doctor or a physiotherapist can teach you exercises to strengthen your arm and wrist.