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Condition/Disorder Synonym

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  • Navicular fracture of the hand

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ICD-9-CM Codes

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  • 814.01 Closed fracture of navicular (scaphoid) bone of wrist

  • 814.11 Open fracture of navicular (scaphoid) bone of wrist

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ICD-10-CM Codes

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  • S62.009A Unspecified fracture of navicular (scaphoid) bone of unspecified wrist, initial encounter for closed fracture

  • S62.009B Unspecified fracture of navicular (scaphoid) bone of unspecified wrist, initial encounter for open fracture

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Preferred Practice Pattern1

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Key Features

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Description

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  • Any defect in continuity of the scaphoid (carpal bone)

  • Displaced (scaphoid is moved on either side of the fracture) or nondisplaced (scaphoid has not moved)

  • Closed (skin is intact) or open (skin is breached)

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Essentials of Diagnosis

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  • Diagnosis is usually made by clinical examination

  • May not be a fracture but a wrist sprain, Colles' fracture, distal radioulnar subluxation/dislocation, or fracture of any other carpal bone

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General Considerations

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  • Most frequently fractured carpal bone (71% of all carpal bone fractures)

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Demographics

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  • Occurs in young and middle-aged adults 15 to 60 years of age

  • Men aged 20 to 30 years are most likely to suffer from a scaphoid fracture

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Clinical Findings

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Signs and Symptoms

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  • Pain at the base of the thumb

  • Point tenderness within the snuff box

  • Edema

  • Loss of general function

  • Loss of active wrist and/or thumb mobility

  • Muscle guarding with passive movement

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Functional Implications

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  • Pain with weight-bearing activities on involved hand

  • Pain with wrist and thumb movements (passive or active)

  • Pain when gripping something

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Possible Contributing Causes

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  • Mechanism of injury

    • Fall on outstretched hand

    • Direct impact (i.e. athletic activity, motor vehicle accident)

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Differential Diagnosis

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  • Colles' fracture

  • Distal radioulnar subluxation/dislocation

  • Wrist sprain

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Means of Confirmation or Diagnosis

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Imaging

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  • X-ray for fracture, often limited view

  • Computed tomography (CT) scan for detailed imaging

  • MRI

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Findings and Interpretation

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  • Pain with passive/active ROM of the wrist and thumb

  • Wrist will often be held in radial deviation

  • Muscle guarding with all movements

  • Inability to actively perform wrist or thumb movements secondary to pain

  • Pain with gripping activities

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Referrals/Admittance

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  • For imaging, x-ray or CT

  • For medication: NSAID or opiod for pain management

  • For immediate orthopedic consult:

    • Distal scaphoid pole fractures are treated non-operatively

      • Immobilization casting of hand and may or may not include thumb

    • Waist or proximal scaphoid pole fractures may be treated:

      • Non-operatively, Immobilization cast of hand and thumb

      • Operatively, open ...

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