HAND FRACTURE, NAVICULAR |
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General Information
DEFINITION--A complete or incomplete break in the navicular bone of the hand.
BODY PARTS INVOLVED
Navicular (scaphoid) bone in the hand.
Wrist joint.
Soft tissue around the fracture site, including nerves, tendons, ligaments and blood vessels.
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SIGNS & SYMPTOMS
Severe pain at the fracture site.
Swelling of soft tissue around the fracture.
Tenderness to the touch.
Numbness and coldness in the hand and fingers, if the blood supply is impaired.
CAUSESDirect blow or indirect stress to the bone. The force is usually inflicted by a fall on an outstretched hand.
RISK INCREASES WITH
Participation in contact sports, especially boxing, football and wrestling.
History of bone or joint disease, especially osteoporosis.
Obesity.
If surgery or anesthesia is needed, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENT
Use appropriate protective equipment, such as boxing gloves for boxing.
If you have had a previous injury, use tape and padding to protect your hand before participating in contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment to manipulate the broken bones and immobilize the injured area.
Hospitalization (sometimes) for anesthesia and surgery to set the fracture.
Self-care during rehabilitation.
Whirlpool, ultrasound or massage (to displace excess fluid from the injured joint space).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor.
X-rays of injured areas, including the wrist joint above and the bones in the hand.
Repeat X-rays may be needed after 2 to 8 weeks if the first set shows no injury but symptoms continue. A third set is sometimes necessary because this injury may not appear on X-rays for several weeks.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissues. AFTER TREATMENT OR SURGERY:
Delayed union or non-union of the fracture (frequently).
Impaired blood supply to the fracture site.
Arrest of normal bone growth in children.
Infection in open fractures (skin broken over fracture site), or at the incision if surgical setting was necessary.
Proneness to repeated hand injury.
Unstable or arthritic joint following repeated injury.
Prolonged healing time if activity is resumed too soon.
Problems caused by casts. See Appendix 2 (Care of Casts).
PROBABLE OUTCOMEIt is impossible to predict exactly how long it will take for any fracture to heal. Variable factors include age, sex, and previous state of health and conditioning. The average healing time for this fracture is 4 to 5 months (an unusually long time for a fracture to heal). Healing is considered complete when there is no motion at the fracture site and when X-rays show complete bone union. Sometimes this fracture never heals totally.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Keep the person warm with blankets to decrease the possibility of shock.
Cut away clothing, if possible, but don't move the injured area to do so.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
Use a padded splint or sling to immobilize the hand and wrist before transporting the injured person to the doctor's office or emergency facility.
The doctor will manipulate and set the broken bones with surgery or, if possible, without. A navicular fracture with separated bone fragments should be manipulated as soon as possible after injury. Six or more hours after the fracture, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position.
CONTINUING CARE
Immobilization will be necessary. A rigid cast or plaster splints are placed around the injured area to immobilize the joint above and the joint below the fracture site.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use a heat lamp or heating pad so heat can penetrate the cast.
After the cast is removed, use frequent ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
MEDICATIONYour doctor may prescribe:
General anesthesia, local anesthesia, or muscle relaxants to make bone manipulation possible.
Narcotic or synthetic narcotic pain relievers for severe pain.
Acetaminophen (available without prescription) for mild pain after initial treatment.
ACTIVITY
Actively exercise all muscle groups not immobilized. Muscle contractions of the arm and hand promote fracture alignment and hasten healing.
Begin reconditioning the hand after clearance from your doctor.
Resume normal activities gradually after treatment. Don't drive until healing is complete.
DIET
Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs.
REHABILITATIONBegin daily rehabilitation exercises when movement is comfortable. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of a hand fracture.
Any of the following occurs after surgery or other treatment:
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Swelling above or below the cast.
Blue or gray skin color under the fingernails.
Numbness or complete loss of feeling in the fingers of the affected hand.
Nausea or vomiting.
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