fractured scaphoid??

[ridenread]

I had a minor crash on my bike almost two weeks ago. My wrist has not been right since. I did a couple of rides since the fall and was in moderate pain during much of the ride especially when I would hit a bump in the road. I figured I had a sprain from the fall but also thought perhaps a fracture. I am an OT should have known better than to keep riding.
Today I finally decided I needed to get it checked out and xrayed. I went to my pcp who then sent me for xrays. Xrays confirmed a scaphoid fracture thus I was then sent to an orthopedic surgeon.
Ortho saw the fracture on one xray but not the others thus recommended a CT scan. CT scan was not conclusive. Thus diagnosed with a wrist sprain and possible mild subluxation. I have a thumb spica splint and an appointment to go back in 4 weeks. I started this process at 10:30 this morning and got home around 7 this evening.
The CT scan is a more reliable test but why would the xray show a clear fracture?

[Thorn]

"Only the Shadow knows"....seriously, shadows. The bones overlap and what appears a a hairline may, indeed, may just be an artifact. Radiology texts have volumes and volumes of normal variants. You'd think something like x-ray would be one area of medicine that is black and white (pun possibly intended), but it isn't.

That said, the scaphoid (aka navicular) is a nasty bone to heal when it breaks. The bone does not have a good blood supply and so it can take longer than the standard 4-6weeks to heal.

If you have concerns and things don't seem to be getting better, pester. In healthcare, you are your best avocate. I don't know if a bone scan works with the scaphoid, but for stress fractures in the leg bones it is often the only way to see fractures before they've healed.

[ridenread]

Thanks Thorn

This morning I received a call from the orthopedist telling me that the radiologist saw a fracture of the trapezium but he does not agree. So now I have a radiologist who saw a fracture on xray, a different radiologist who saw a fracture on CT scan and an ortho who sees nothing . I think I am going to get a second ortho consult.

[OakLeaf]

If it were me, I'd ask the ortho what the difference, if any, would be in the initial treatment.

[Xrayted]

The radiologist is the expert on xrays, not the orthopedist. The rad has a massive, high resolution monitor that shows them the minute details of the bones, the ortho doesn't. It gets missed easily all the time by docs and specialists where the rad catches it. My question is... did they do a navicular shot of your wrist or not? That would be where your hand is extended out to the side. Your hand could either be flat on the table or tilted up, thumb side about 1" or 2" off the table. Like, it would be stretching the side your thumb is on. It is very easy to miss a scaphoid fx if they didn't stress that side of your joint when doing the pics. The stress view would pull the two pieces apart enough to show it. I always just do a scaphoid view when someone says they hurt at that spot. It saves them the extra xray (radiation and larger bill) and shows definitely one way or another if it's fx'd. It's a good one to show the trapezium as well or a chipped/dislocated/arthritis 1st metacarpal joint problem.

If your scaphoid is fx'd but lined up, they usually just splint you in a semi hard cast for a few months. It does take longer to heal than other bones. If it's not lined up (which would make no sense in your case because that is easily seen) or won't heal on it's own, they would have to put a small pin in there until it healed. The trapezium pretty much ends up healing on it's own with a splint ro they can do a pin.

Here's what bones you are talking about...



and here is how they should have turned your wrist to see if you have scaphoid bone fx.



this is a pic of fx'd scaphoid that has a pin in it. it would be hard to tell if it was fx'd, as you can see, without stressing that side and pulling it apart a bit.



I hope this info helps! I'll be watching to see what you find out and I hope you get better soon. Stay off of the handlebars until you know one way or the other. That is a hard bone to get to heal and can really affect you for life if you don't give it time and do it right.

[ridenread]

Thanks xrayted! That is great info and the visual to go along with it. I do not recall them taking a shot with my hand positioned the way you describe or show but it was a really long day so I really don't remember. I remember fist with palm down, open hand palm down and open hand palm up and one with radial side up and fingers fisted

I have another visit on Tuesday with a second orthopedist at a different practice. I have never sought out a second opinion in my 47 years so this is a first. I just don't feel right with his recommendation when two radiologists from two different places both saw fractures.

Oakleaf his recommendation for treament was to put it in a cast for 3 months if it is broken and to do nothing if it is not broken. He did make me a 30 second semi soft spica to wear while we were waiting for the CT scan. I wore it part of the day today but it was making the pain worse than it has been for the past 13 days.

I got myself a thumb spica wrist splint to wear until Tuesday so I am at least holding in a stable position if it is broken.

[Xrayted]

Hmmm. Get a 2nd opinion and probably new x-rays. No wonder they had a hard time diagnosing. In the way you described, none of those shots would be conclusive to show a scaphoid fx. Not even close.

Kudos to the radiologists for seeing something. Wow.

[maryellen]

Hi ridenread,

I had a somewhat similar experience after a crash. Nothing showed up despite repeated xrays but as I was still complaining about it (after shoulder surgery on the other side!), my surgeon ordered an MRI which did resolve the question. It turned out to be a fracture right at the base of the 1st metacarpal. Fortunately no surgery was necessary. I wore a splint for several weeks. I feel it a bit when I do too much chopping in the kitchen but no problem on the bike!

Hope you have the best possible outcome.
Maryellen

[ridenread]

I had a second opinion consult on my wrist today. Xrays and CT scan not conclusive. There are abnormaliites in both the scaphoid and trapezium but not sure if they are fractures. I need to have an MRI to confirm and it will take 3-5 days to get insurance authorization and an appointment.
So I am still to wear a splint and stay off of the bike.