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What is a navicular fracture of the wrist?
A navicular fracture is a
break in a small bone on the thumb side of your wrist. Of the eight carpal
bones in your wrist, your navicular bone is the most likely one to break.
It is important to find out if you have a navicular fracture, because
navicular fractures need treatment to heal well. With proper treatment and
follow-up, most navicular fractures will heal over time. Without treatment, and
sometimes with treatment, healing can be slow and difficult because parts of
the navicular bone don't have a good blood supply. If your navicular bone does
not heal well, you can have long-term pain, stiffness, or
arthritis in your wrist.
What causes a navicular fracture?
fractures occur when you stretch your hand out in front of you to protect
yourself from a fall. They can also occur when your wrist twists severely or is
hit very hard. Navicular fractures often happen while a person is playing sports
such as football, soccer, or basketball or during activities such as
Rollerblading, skateboarding, or bike riding. They can also occur as a result
of a car crash or a fistfight.
What are the symptoms?
Because most navicular fractures do not
cause the wrist to look broken and many cause only minor symptoms, it can be
hard to know if your navicular bone is broken. If the bone is broken, you may
It can be hard to tell the difference between a wrist that
sprained and one that is broken. If you have fallen on
an outstretched hand and your wrist hurts, be sure to see a doctor to find out
if you have any broken bones. Navicular fractures that are not treated properly
can lead to long-term problems.
How is a navicular fracture diagnosed?
Your doctor will ask you questions
about your symptoms and about how and when you hurt your wrist. He or she will
then look at your wrist, find any swollen or tender areas, and see how well you
are able to move your wrist and thumb. Your doctor will also try to find out
how well blood is flowing to your hand and if you have any nerve damage in your
Most likely, your doctor will order
X-rays of your wrist. Sometimes an X-ray clearly shows
a navicular fracture. Other times, an X-ray may not show signs of a fracture. If
your doctor is not sure if your wrist is broken, he or she may refer you to an
orthopedist, a doctor who specializes in bone
problems. Because fractures can't always be seen right away, you may need a
follow-up X-ray in 1 to 2 weeks. In the meantime, to prevent possible long-term
problems, you will be treated as if you do have a fracture.
some cases, other imaging tests such as
CT scans, and
bone scans are used to look for navicular fractures.
How is it treated?
for navicular fractures includes wearing an arm cast or splint and sometimes
having surgery. Even if the first X-rays do not show a fracture, your doctor
still may treat you to prevent possible problems with healing.
Right after the injury, you may wear a splint because your wrist is too
swollen to put a cast on. You may also wear a splint if it is not clear whether
your bone is broken. For the first few days, your doctor may tell you to keep
your wrist higher than the level of your heart and to use cold packs or ice to
reduce swelling. He or she may also prescribe a pain medicine or suggest a pain
medicine that you can buy without a prescription, such as acetaminophen (for
example, Tylenol) or ibuprofen (for example, Advil or Motrin).
some cases, after the swelling is gone, the splint will be removed and a cast
will be put on. The cast will enclose your thumb and may extend above your
elbow. Some people only need to wear a cast for 6 weeks, while others may have
to wear a cast for several months. How long your wrist takes to heal depends on
how serious your fracture is. Regular visits to your doctor will help you to
know how well your fracture is healing and learn how to care for your splint or
In other cases, you may need surgery to put pieces of your
bone in the proper place or to help your bone heal faster. You may also need
surgery if part of your bone has died because it did not get enough blood. If
you have surgery, you will need to wear a splint or cast afterward.
Once a splint or cast is removed, your arm or wrist may feel weak or
stiff. Your doctor or a
physical therapist can teach you exercises to
strengthen your arm and wrist.
Other Works Consulted
Bednar MS, Light TR (2003). Hand surgery. In HB
Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 3rd ed., pp. 525–572. New York: McGraw-Hill.
Uehara DT, et al. (2004). Wrist injuries. In JE
Tintinalli et al., eds., Emergency Medicine: A Comprehensive Study Guide, 6th ed., pp. 1674–1684. New York: McGraw-Hill.
October 11, 2012
William H. Blahd, Jr., MD, FACEP - Emergency Medicine & David Messenger, MD
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