Scaphoid fracture ED leaflet

You have been seen in the Emergency Department and suspected to have a fracture of the scaphoid bone, a bone at the base of the thumb.

Your initial treatment will be a plaster cast to stop movement of your wrist and thumb, to help the bones heal. You will need it for four to six weeks. You may use the hand as pain allows.

Take pain killers as prescribed to manage any pain and swelling.

We have referred you to the fracture clinic and they will manage your ongoing care. Please make sure we have your latest contact details.

If you have not received a follow-up appointment from the hand and wrist fracture clinic within three working days, call them on telephone 01273 696 955 extension 4116.

Please return to Emergency Department immediately if you are affected by any of the following

• Increased pain.
• Increased swelling.
• Numbness or pins and needles in the affected arm.
• Inability to move your fingers.
• Blueness of the fingers.
• If the plaster cracks, becomes loose or is rubbing your skin.

The scaphoid bone is situated on the thumb side of the hand, it may be injured by a fall on an outstretched hand, by a blow to the wrist or from punching.

Some fractures of the scaphoid are not always visible on the initial x-ray and further imaging may be necessary to confirm the presence of a fracture.

Even if the doctor cannot see a fracture on the initial x-ray, when they examine you, if they suspect the bone may be broken, they will treat it as a fracture until confirmation.

The treatment involves putting a plaster cast on your forearm. This will have plaster on one side and not all over, and then be covered in bandages.

Take pain killers as prescribed to help with any pain or swelling.

You may use the hand as pain allows.

You should keep your arm elevated in a sling as this will reduce swelling and may help reduce your pain.

A scaphoid fracture normally takes approximately 4 to 6 weeks to heal. The cast is to help the bones heal.

You will be referred for review by the orthopedic team via the fracture clinic. They will arrange for your ongoing care.

If you are having problems or discomfort with the cast please speak to the fracture clinic or your GP.

To ensure you are progressing as expected you will be reviewed in fracture clinic in about 2 weeks.

The plaster applied in the Emergency Department may be changed to a plaster all around the forearm especially if there is not much swelling when they examine your arm.

You may be seen again in fracture clinic around 4 to 6 weeks after your injury to remove the cast and to be seen by one of the hand team.

Fractures of the scaphoid can occur in different parts of this bone and some type of fracture can experience delays or failure to heal on their own. As a result, some patients require an operation to fix the bone. In general it can take up to 6 months for the fracture to heal; most patients will be x rayed at that time to confirm healing of the fracture.

0 – 6 weeks after the injury.

• Your initial treatment will be via a plaster cast immobilising the wrist and thumb but afterwards you may require surgical treatment.

• Your arm will be in a cast for 4 to 6 weeks. You will be given a care of your plaster cast leaflet; this will contain dos and don’ts of looking after your cast.

• You will be reviewed in fracture clinic around 2 weeks post injury. You may have further imaging to confirm the fracture occurred and to review the current healing process.

6 to 12 weeks after the injury.

• You will be seen again in fracture clinic in 6 to 12 weeks to remove the cast and be seen by the hand team. The injury should have healed within this time but heavy tasks or lifting may still be uncomfortable.

• Another x ray will be taken out of plaster to see how well the bones are healing. The doctor will assess you and if you are experiencing pain a splint will be applied instead of the plaster.

12 weeks after the injury.

• If you are still experiencing significant pain and swelling after 12 weeks then please contact the Fracture Clinic for advice.

You should see your GP or contact the Hand and Wrist Fracture Clinic telephone 01273 696 955 extension 4116.

• If you are experiencing new pain or symptoms.
• Or you have any questions.

For general medical advice please use the NHS website, the NHS 111 service, walk-in centres, or your GP.

The NHS website provides online health information and guidance www.nhs.uk.

NHS 111 phone line offers medical help and advice from trained advisers supported by nurses and paramedics. Available 24 hours a day. Calls are free from landlines and mobile phones.

There are walk-in and urgent treatment services at Brighton Station, in Crawley and at Lewes Victoria Hospital. www.bsuh.nhs.uk/services/ae/.

Patient Advice and Liaison Service (PALS) can be contacted with your comments and concerns, and to provide general support. Email PALS@bsuh.nhs.uk.

RSCH, telephone 01273 664683.

PRH, telephone 01444 448678.

PALS, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE.

This information is for guidance purposes only and is in no way intended to replace professional clinical advice by a qualified practitioner.

This article is intended for patients receiving care in Brighton & Hove or Haywards Heath.