UNC celebrates making it to the Sweet 16, but sophomore point guard, Kendall Marshall suffered a scaphoid fracture in his wrist.  Will he be back for the rest of the tournament?

ANATOMY

The hand and wrist are made up of 27 bones.  At the base of the hand, in the wrist, there are 8 bones.  The scaphoid bone is a wrist bone that sits at the base of the thumb.  

The scaphoid can be most easily recognized when one makes a “hitchhiker’s” sign.  At the base of the thumb, a hollow is created.  At the base of the hollow lives the scaphoid bone.

CAUSES

A fracture of the scaphoid is usually caused by a fall on an outstretched hand, with the weight focusing through the palm.  This type of injury is seen in young adults, but can really happen in any group. 

There are different types of scaphoid fractures.  Those closer to the thumb do better, as the blood supply to this part of the bone is good.  Those that are more central, or in the “waist” of the bone, or closer to the forearm may have more of a difficult time healing.  This part of the bone has a poor blood supply and the bone may not heal. 

SYMPTOMS

Individuals who break the scaphoid will have pain, swelling, loss of motion, and bruising.  Their can be pain in the “hollow” or “snuffbox”, difficulty with creating the “hitchhiker” posture,  or pain with grip.

WHEN TO SEEK MEDICAL CARE

If you suspect that you are suffering from a broken scaphoid, you should seek medical attention within a day or two of the injury.  A physical exam and x-rays are usually performed. A CT or MRI scan at times may be needed.

TREATMENT

Scaphoid fractures that are closer to the thumb may be successfully treated with a short arm cast that captures and immobilizes the thumb.  The cast is usually worn for 6 to 8 weeks.

Scaphoid fractures that are at the waist of the bone or closer to the forearm can be problematic. Although a thumb immobilized cast can lead to healing, at times, this may not be enough.  Since the blood supply to this part of the bone is poor, the bone may not heal.  For this reason, often times, a surgical procedure is recommended. 

Surgery is considered in scaphoid fractures that occur at the waist of the bone, closer to the forearm, or those fractures that have not healed.  In any of these surgical situations, a screw is placed in the bone to hold the pieces of the bone together and optimize the contact between the pieces.  A cast is still required and can be worm for 3 months or more.

OUTCOMES

Scaphoid fractures can be career ending for an athlete.  These injuries can affect grip strength and motion.  Occupational therapy is critical to regain motion and strength. 

RETURN TO ACTIVITIES

From the current reports, it is unclear if Marshall will need surgery.  It is unlikely for him to return for the rest of the tournament.

VIDEO/ANIMATIONS

Dr. P

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All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

Jay Cutler, quarterback for the Chicago Bears, underwent surgery today for a Bennet’s fracture or break on his throwing thumb.  What is this injury?  Can he make it back to play this season?

ANATOMY

The human hand is composed of 27 bones.   These bones are grouped into categories:  the carpal, metacarpal, and phalanges.  The human hand has five metacarpals. 

A Bennett’s fracture is a break at the base of the metacarpal of the thumb.  

This injury is usually accompanied by a dislocation or a subluxation (partial dislocation) of the thumb.  This injury makes the thumb unstable, particularly for gripping activities, such as holding a football.

There are a number of strong ligaments and tendons that attach to the smaller piece of bone that is broken. 

CAUSES

The most common causes of Bennett’s fractures are: a punch or a direct blow against a football helmet or skull, or a fall, particularly while holding a handle bar of a bike or motorcycle.

SYMPTOMS

Athletes with a Bennett’s fracture will have pain at the base of the thumb.  There will be instability of the thumb with gripping or pinching motions.   There will be weakness with these activities as well. There will be pain, swelling and bruising around the base of the thumb.

TREATMENTS

Athletes with a Bennett’s fracture will require surgery.  Surgery can be performed in a variety of manners:  with small incisions and screws, with screws and plates, or with pins alone.  If the smaller piece is very small and not out of place, a “thumb” spica cast can be placed for non surgical treatment.  Whether surgical or non surgical treatment is performed, a cast for 4-6 weeks is needed.

WHEN TO SEEK MEDICAL CARE

If you suspect that you have a Bennett’s fracture, you should seek medical care within hours of the injury.  A good physical exam, x-rays, and perhaps a CT scan or MRI may be needed to evaluate the hand.

RETURN TO ACTIVITIES/OUTCOMES

Regardless of the type of treatment, a cast is needed for 4-6 weeks.  Thereafter, physical therapy and rehabilitation is required.  It is usually 6 to 8 weeks before throwing activities can be started without pain.

If lucky, Cutler may be able to return late this season, especially if the Bears make is deep into the playoffs. 

Dr. P

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics