What is the Scaphoid?
It is a small carpal bone which is boat-shaped and found on the thumb side of the wrist.
How does a scaphoid fracture usually occur?
A history of how your injury occurred is important in making the diagnosis. It typically occurs when you fall onto your outstretched hand, so your palm is flat and your wrist is bent back. Ouch! Very rarely a direct blow to your hand can cause a scaphoid fracture. It is common in young athletic types who have fallen over whilst playing sport.
How is a scaphoid fracture diagnosed?
Usually, there will be pain at the time of the injury, swelling and certain movements of the wrist will be painful.
A doctor will look for tenderness in the” anatomical snuff box”. So, what is an anatomical snuffbox?
It is an area of depression in the skin at the very base of your thumb, supposedly where gentlemen or women used to place their snuff before sniffing!
Were adequate views of your scaphoid bones taken? Scaphoid fractures are not always easy to spot on standard x-rays. If a scaphoid fracture is suspected, a doctor should order special scaphoid views to be taken with your wrist held in certain positions, to identify or exclude a scaphoid fracture. Sometimes these fractures are not identifiable straight away and so repeat X-rays should take place after 10 to 14 days. Occasionally, if still not detected, a CT scan or MRI may be arranged if such a fracture is suspected.
How is a scaphoid fracture treated?
It depends on whether the fracture is displaced or not. If it is not out of place, or a scaphoid fracture is suspected but not yet confirmed, your arm is usually placed in a cast up to your elbow for 6 to 12 weeks until your scaphoid bone heals. Sometimes it can take longer to heal.
If it is displaced, it is likely that surgery will be needed. This involves placing a small screw or pin into the Scaphoid bone to secure the bony fragments together in the correct position. This means that usually you do not need to wear a cast for as long, so you can return to your usual activities quicker.
What can be the long term consequences of a delay in diagnosing a Scaphoid fracture?
If not diagnosed and treated promptly, there can be long term problems such as delayed healing or non-union of the fracture. Another complication is malunion, where the bone heals in the wrong position, causing problems and pain with gripping and holding objects. More complex surgery may be needed to correct this which involves bone grafting to aid healing.
Another complication of delay can be avascular necrosis. This is where the blood supply to this bone is stopped and causes the bone to collapse. This can occur some months after the initial fracture if not treated and diagnosed promptly. Longer-term, non-union, malunion, or avascular necrosis, can lead to premature osteoarthritis occurring in the joint which can cause restrictions in using your wrist.
How much compensation will I get for delayed treatment of a scaphoid fracture?
Examples of some past settlements appear below.
£267,000 compensation for a 34-year-old man after a failure to diagnose and treat a Scaphoid fracture following a fall onto his dominant right hand during a game of football.
He attended A&E complaining of immediate pain and swelling to the wrist. X-rays were taken but were interpreted as showing no bony injury. He was discharged with an advice sheet but no follow-up arrangements were made. He continued in pain and was unable to lift any heavy objects, grip or apply force through his wrist in his job as a carpenter.
After several trips to his GP and physiotherapy, further x-rays revealed a non-united fracture of the Scaphoid. He underwent internal fixation surgery which included bone grafting. It was alleged there were multiple failures to consider a diagnosis of Scaphoid fracture, to examine and find tenderness in the anatomical snuff box, to arrange special scaphoid x-ray views, to diagnose the Scaphoid fracture, to arrange for him to be re-examined within 14 days, and to treat by immobilising in a cast.
It was alleged that if the Scaphoid fracture had been diagnosed and treated sooner, by being immobilised in a cast, it would have healed without the need for surgery and with few if any, residual symptoms. He would have been able to return to his role as a carpenter and carry out household chores, DIY and gardening without limitation. Instead, he was left with permanent and significant pain and reduced grip strength as well as restricted movement and stiffness in his wrist. He had to give up his employment as a carpenter due to this and found employment as a part-time cloakroom attendant in a nightclub. He was very restricted in relation to DIY and gardening tasks, couldn’t carry out any cooking or housework which involved lifting heavy objects, and was limited in his ability to help out with the care of his young child. He suffered from psychological adjustment disorder and depression.
Liability was admitted but the extent of harm caused by the failures in treatment was disputed. An out-of-court settlement was reached.
This shows that claims of this nature can be worth substantial compensation particularly where there is an impact on someone’s ability to work and carry out household chores and DIY/gardening and if there is a risk of developing osteoarthritis in the future.
£35,000 to a 37-year-old man for a failure to diagnose a Scaphoid fracture in October 2005 which went undiagnosed for a period of four years!
When he attended the A&E department of the defendant hospital on 14 October 2005, having injured his dominant right wrist, on examination the doctor noted there was no swelling, bruising nor bony tenderness and that he was neurovascularly intact. An x-ray was carried out and he was discharged home and advised to rest. He continued to suffer from pain and discomfort but persevered using his wrist.
Following a course of private physiotherapy, he was referred to a consultant orthopaedic surgeon in 2008. An x-ray demonstrated a non-united fracture of the Scaphoid. He underwent internal fixation and bone graft surgery. He remained in a cast for six weeks and once the CT scan had confirmed that the bone graft had been successful, he underwent further surgery to remove the screw.
It was alleged that there was a failure to properly examine the Scaphoid, a failure to appreciate that undisplaced Scaphoid fractures were often not visible on initial x-rays taken shortly after the initial injury, failing to treat a suspected Scaphoid fracture by immobilising the wrist, failing to carry out a repeat x-ray between 7 to 10 days after the initial assessment, and alternatively, failing to refer him immediately for an MRI scan. It was alleged that with reasonable care he would have avoided the need for surgery and the symptoms that he suffered. Liability was admitted in this case.
His condition was only expected to improve to 90% within the next couple of years It was unlikely he would be able to fully load an extended wrist which would cause him some minimal problems throughout his life. An out of court settlement was reached.