Los Angeles Hand Surgeon

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Animal and Human Bites
Arthritis at Base of Thumb
Brachial Plexus Injury
Carpal Tunnel Syndrome
Congenital Hand Differences
Cubital Tunnel Syndrome
De Quervain's Tendonitis
Dupuytren's Disease
Extensor Tendon Injuries
Fireworks Accident
Flexor Tendon Injuries
Ganglion Cysts
Hand Fractures
Hand Infections
Kienböck's Disease
Nail Bed Injuries
Nerve Injuries of the Hand
Osteoarthritis of the Hand
Prosthetics and Amputation
Reflex Sympathetic Dystrophy
Rheumatoid Arthritis
Scaphoid Fractures
Scaphoid Non-Union
Tendon Transfer Surgery
Tennis Elbow
Thumb Sprains
Trigger Finger
Vascular Disorders
Wrist Arthroscopy
Wrist Fractures
Wrist Sprains

Diagnosis Model
Hand Diagnosis Model


Call our offices at:
(310) 274-3481
(800) 964-0404

Beverly Hills
9301 Wilshire Boulevard
Suite 406A
Beverly Hills, California 90210

We accept most types of insurance providers and specialize in the treatment of workers' compensation injuries to the hand and upper extremity.

Scaphoid Fractures

Causes of a Scaphoid Fracture
Diagnosis of the Wrist
Treatment of a Fractured Scaphoid
Complications of the Fracture

There are eight bones lined up in two rows in the wrist that, as a unit, are referred to as the carpal bones. The row closer to the hand is called the distal row, and the one closer to the forearm is the proximal row. The scaphoid bone is the only one that is part of both rows, which makes it the most likely bone in the wrist to be injured.

Scaphoid Fracture

Causes of a Scaphoid Fracture
The scaphoid is fractured most often when someone falls and lands on an outstretched hand meant to break the fall. Instead of breaking the fall, the wrist itself painfully fractures. It is rare for any sign of the fracture to show up, and since there is no bruise or extreme swelling, it's easy for someone to think it was just a simple sprain and not have the injury examined by a hand surgeon. Sometimes it may be months or years before the fracture is discovered.

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Diagnosis of the Wrist
X-rays of the wrist are the usual way to diagnose a scaphoid fracture, but unless the scaphoid was moved out of place, x-rays taken in the week after the injury may not show the fracture and it may be considered a sprain.

If the area right above the scaphoid, in the hollow "snuffbox" where the thumb meets the wrist, is very tender, a scaphoid fracture is likely and a splint should be used to protect the bone. A couple weeks after the injury, a second x-ray will usually confirm whether or not the scaphoid was fractured by showing changes in the bone at the sight of the fracture.

Sometimes it may be hard to wear a splint for two weeks, or the second x-ray might still fail to show the fracture even though the hand surgeon feels it is likely. While they cost more than an x-ray, an MRI, CT, or bone scan can often show if the scaphoid was fractured.

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Treatment of a Fractured Scaphoid
If a fractured scaphoid didn't move, a cast that covers the forearm, hand, and thumb is used to keep the wrist stable until the bone heals. This can take as few as six weeks, but since the supply of blood to different parts of the scaphoid can be so different and may have been changed by the injury, it may take longer for the bone to heal.

The part of the scaphoid that is closest to the forearm is the most susceptible to having its blood supply reduced or eliminated. This can lead to that part of the scaphoid dying. To correct that, or if the fracture happened in that part of the bone, or the scaphoid was moved by the injury, surgery may be needed to repair the fracture. During the surgery, the hand surgeon will use pins or a screw to hold the bone together, and may graft some additional bone onto the scaphoid.  
Fractured Scaphoid
Using pins or screws to keep the bone stable may be the better treatment even when the scaphoid hasn't moved or has adequate blood supply.

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Complications of the Fracture
Scaphoid Non-Union: Unless the fracture is identified and treated, the scaphoid isn't likely to heal on its own. Since the supply of blood can be affected by the injury, even with treatment, the scaphoid may not get enough blood to heal, and this can lead to eventual arthritis if it fragments or becomes mis-aligned. Surgery can correct the scaphoid and help it heal if the fracture is treated before the arthritis develops.

Avascular Necrosis: If the supply of blood to the scaphoid is reduced enough, part of it may die. This usually causes the scaphoid to collapse in fragments and results in arthritis. Surgery to repair the blood supply can keep this from happening, but only if the surgery is attempted before arthritis presents itself.

Post-Traumatic Arthritis: If not caught before arthritis develops, surgery to remove dead or dying bone, or to fuse part of the wrist joint, might be considered just to save what is left and keep it from getting worse.

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We serve the following cities within Los Angeles, which are in close proximity to our offices:
Agoura Hills, Brentwood, Canoga Park, Century City, Chatsworth, Culver City, Glendale, Granada Hills, Hollywood, Los Angeles, Marina Del Rey, North Hollywood, Northridge, Rancho Park, Reseda, Santa Monica, Sherman Oaks, Studio City, Tarzana, Valencia, Van Nuys, West Hills, West Hollywood, West L.A., Winnetka, Woodland Hills