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Scaphoid bone

The scaphoid bone, also known as the navicular bone, is the largest of the eight carpal bones in the human wrist and is classified as a short bone with a distinctive boat-like shape. It is positioned in the proximal row of carpal bones on the radial (thumb) side, articulating proximally with the distal radius to form part of the radiocarpal joint and distally with the trapezium bone, while also connecting with the lunate, capitate, and trapezoid bones. This strategic location enables the scaphoid to bridge the proximal and distal carpal rows, facilitating essential wrist movements such as flexion, extension, radial deviation, and ulnar deviation, thereby contributing significantly to overall hand mobility and stability. Structurally, the scaphoid features a proximal surface, a convex distal surface, and a prominent on its palmar aspect that forms part of the floor and serves as an attachment site for the flexor retinaculum and . Its blood supply is uniquely retrograde, primarily derived from branches of the entering at the distal end and flowing toward the proximal pole, which makes the bone particularly vulnerable to in cases of injury. Clinically, the scaphoid is the most frequently fractured carpal bone, often resulting from falls on an outstretched hand, with tenderness in the —a triangular depression on the radial —serving as a key diagnostic indicator. Such fractures can disrupt the bone's precarious vascularity, leading to delayed healing or , and may necessitate , surgical intervention, or advanced imaging for proper management.

Anatomy

Gross anatomy

The scaphoid bone is the largest of the four bones in the proximal row of the , positioned on the radial () side of the , where it lies between the distal proximally and the bases of the first and second distally, adjacent to the lunate medially. It exhibits a distinctive boat-shaped , reflecting its Greek-derived name "scaphoid" meaning , with a twisted, peanut-like structure that spans the proximal and distal carpal rows. The bone is divided into three primary regions: a smaller, rounded proximal pole; a narrow, constricted in the central portion; and a broader distal pole that includes a prominent palmar serving as an attachment site for ligaments such as the transverse carpal ligament. The scaphoid is oriented obliquely within the , with its long axis aligned at approximately 45 degrees to the longitudinal axis of the in both the coronal and sagittal planes, facilitating its role as a bridging element between the and hand. Average dimensions vary by sex, with males typically exhibiting a length of 31.3 mm (standard deviation ±2.1 mm) and females 27.3 mm (±1.7 mm) along the long axis from the proximal pole to the distal articular surface; width measurements narrow at the waist to about 13.6 mm in males (±2.6 mm) and 11.1 mm in females (±1.2 mm), while the proximal pole measures around 4.5 mm in males (±1.4 mm) and 3.7 mm in females (±0.5 mm). Key surfaces of the scaphoid include a smooth, convex proximal articular surface that interfaces with the scaphoid fossa of the distal radius, forming part of the radiocarpal joint. The distal surface is convex and subdivided by a central ridge into two facets for articulation with neighboring carpals, while the medial surface is concave for contact with the lunate. Additionally, a dorsoradial ridge on the dorsal aspect provides attachment points for ligaments, including the dorsal intercarpal ligament. Over 75% of the bone's surface is covered by articular cartilage, emphasizing its extensive joint interfaces.

Articulations

The scaphoid bone, the largest in the proximal carpal row, articulates with five adjacent structures, facilitating its central role in stability and motion. Proximally, its convex surface forms the with the scaphoid fossa of the distal . Distally, a bony divides the surface into radial and ulnar facets: the radial facet articulates with the and bones at the midcarpal , while the ulnar facet connects to the capitate. Medially, a smooth concave surface joins the lunate, also at the midcarpal . These articulations exhibit varied morphologies to accommodate multiplanar movements. The proximal radiocarpal interface is a with the convex scaphoid articulating against the radial . The medial scapholunate and scaphocapitate contacts are -convex, with the scaphoid's ulnar border enhancing interlocking stability. Distally, the scaphotrapezial features saddle-like contours for rotational capacity, while the scaphotrapezoid articulation is relatively planar. Approximately 75% of the scaphoid's surface is covered by articular , underscoring its extensive involvement. Ligamentous attachments reinforce these joints, with the scaphoid serving as a key anchor point. Volarly, the radioscaphocapitate ligament spans from the radius to the scaphoid and capitate, stabilizing the proximal articulation; the scapholunate interosseous ligament, a C-shaped intrinsic structure with dorsal, volar, and membranous components, binds the scaphoid to the lunate, linking the proximal and distal carpal rows. Additional volar supports include the scaphocapitate, scaphotrapezial, and scaphotrapezoid ligaments, attaching to the distal pole and tubercle. Dorsally, the dorsal radiocarpal and dorsal intercarpal ligaments secure the proximal and waist regions, preventing excessive extension. The only direct musculotendinous attachment on the scaphoid is the origin of the abductor pollicis brevis muscle on its tubercle. The scaphoid's unique , including volar (palmar) concavity and convexity along its , optimizes these articular interfaces for load distribution and motion facilitation without compromising stability. This curvature, combined with the , positions the scaphoid as a pivotal connector between carpal rows.

Blood supply

The blood supply of the scaphoid bone is primarily derived from branches of the , which enter through nutrient foramina located along the non-articular ridge, particularly at the distal pole. These branches, originating from the carpal branch of the , provide the major vascular input, accounting for approximately 70-80% of the intraosseous blood supply. The blood flow within the scaphoid is predominantly retrograde, traveling from the distal pole proximally through the bone's to nourish the waist and proximal pole regions. A secondary source of vascularization comes from the superficial palmar branch of the (or occasionally the anterior interosseous artery), which supplies the distal on the palmar aspect via smaller foramina. This volar supply contributes the remaining 20-30% of the blood flow and primarily perfuses the distal third of the bone, with limited contribution to more proximal segments due to the bone's predominantly articular surfaces that restrict extraosseous vessel penetration. The distal is well-vascularized by both and volar inputs, the receives moderate retrograde flow from the primary dorsal branches, and the proximal depends almost entirely on these distal-derived vessels, making it particularly vulnerable to disruption. The retrograde nature of the scaphoid's blood supply has significant clinical implications, as —especially those in the proximal pole—can interrupt this flow, leading to in 13-50% of cases, with higher rates in proximal fragments. This vulnerability arises because the proximal pole lacks direct extraosseous supply, relying solely on intraosseous that is easily compromised by or formation at the fracture site.

Anatomical variations

The scaphoid bone displays several normal anatomical variants that deviate from the typical morphology, influencing its shape, size, and ligamentous attachments. One common variant involves the os centrale carpi, an accessory ossicle derived from an independent ossification center that often fuses to the distal scaphoid, with a prevalence of 0.3-1.6% in the general population; this fusion can appear as a transverse lucency on radiographs, mimicking an acute fracture. Variations in the transscaphoid arc, which refers to the curvature and orientation across the bone's waist, include differences in overall and angulation that affect carpal . For instance, scaphoid may vary between approximately 18-20 mm depending on morphological type, with type 1 scaphoids (40-58% prevalence) exhibiting longer dimensions and greater angulation of attachments (e.g., dorsal intercarpal at 31.6° ± 6.32°) compared to type 2 (41.8-60% prevalence) at 18.4 mm and 14.7° ± 2.11°; the flexion arc of the scaphoid typically spans 120-150 degrees in normal motion, though individual variations influence this range. The size of the scaphoid tubercle also varies, with prominent forms occurring in 10-15% of cases, often associated with type 1 where the tubercle is more pronounced, impacting the attachment sites of volar ligaments such as the radioscaphocapitate. Rare fusions, such as congenital scaphoid-lunate coalition, have an incidence of less than 1% and represent about 2% of all carpal coalitions, typically presenting as osseous or fibrous bridging without clinical symptoms unless associated with instability.

Function

Kinematics

The scaphoid bone primarily participates in flexion-extension, contributing approximately 45-60 degrees of motion, which is coupled with radial-ulnar deviation of 20-30 degrees overall in the complex. During flexion, the scaphoid flexes significantly, often reaching up to 70% of the capitate's flexion, while in extension, it extends to about 74% of the capitate's range, facilitating smooth proximal-distal carpal row coordination. This coupled motion underscores the scaphoid's role in enabling multiplanar mobility without isolated axial rotation. A key kinematic feature is the scaphoid shift, where during radial deviation, the scaphoid flexes and pronates as the approximates the , promoting palmar flexion; conversely, in ulnar deviation, it extends and supinates as the hamate rotates, aligning with dorsal extension. This dynamic shifting maintains carpal and influences adjacent bones like the lunate through ligamentous connections. As a of the carpus, the scaphoid links the proximal row (scaphoid, lunate, triquetrum) to the distal row via the midcarpal joint, ensuring synchronized intercarpal motion during excursions. In the neutral position, the scaphoid adopts a flexion-pronation posture, angled at approximately 45 degrees (range 30-60 degrees) relative to the lunate and capitate, due to inherent ligament tensions that balance compressive loads. The scaphoid contributes to the dart-thrower's motion, an oblique plane combining radial extension and ulnar flexion, where it undergoes balanced flexion-extension with minimal proximal row translation, divided equally between radiocarpal and midcarpal contributions for functional stability.

Load transmission

The scaphoid bone plays a critical role in load sharing across the wrist, transmitting approximately 50-70% of axial compressive forces from the radius to the distal carpal row during wrist compression in neutral or extended positions. This distribution ensures efficient force transfer while minimizing stress on adjacent structures like the lunate, which bears about 35% of the load. In dynamic scenarios, such as gripping or weight-bearing, this mechanism supports overall wrist function by balancing loads between the proximal and distal carpal rows. Stress distribution within the scaphoid is uneven, with the waist region—its narrowest portion—experiencing the highest forces. These forces arise from the bone's orientation and the 's hyperextension, concentrating shear at the waist and predisposing it to mechanical vulnerability under high-impact conditions. The scaphoid's stabilizing role further enhances load transmission by resisting carpal collapse through tension in the scaphoid-lunate ligament, which maintains alignment between the proximal under compressive loads. Biomechanically, the scaphoid exhibits (approximately 60 ) to withstand these axial loads, yet its narrow waist confers low torsional resistance, making it susceptible to twisting stresses. This configuration influences stability by preserving neutral alignment of the proximal carpal row, thereby preventing dorsal intercalated segment instability (DISI) during normal loading.

Clinical aspects

Fractures

Scaphoid fractures represent the most common type of carpal injury, accounting for approximately 60-70% of all carpal fractures and 2-7% of all fractures. These injuries predominantly affect young adults, with a mean age of around 29 years, often occurring in males due to high-energy . The typical mechanism involves a fall on an outstretched hand (FOOSH) with the in hyperextension and radial deviation, leading to axial compression of the scaphoid against the dorsal rim of the , particularly fracturing the waist region. Fractures are classified either anatomically by location or using the , which assesses and guides management. Anatomic classification divides fractures into proximal pole (about 20%), (70%), and distal (10%), with fractures being the most frequent due to the bone's vulnerability to compressive forces in that region. The categorizes them as follows: Type A (stable acute fractures, including tuberosity and A2 incomplete ); Type B (unstable acute fractures, including B1 distal oblique, B2 complete , B3 proximal pole, and B4 trans-scaphoid ); Type C (delayed union); and Type D (established , with D1 fibrous and D2 sclerotic subtypes). Unstable fractures, such as those in the proximal pole or with displacement greater than 1 mm, carry higher risks due to potential disruption of the retrograde blood supply entering distally. Healing of scaphoid fractures is often prolonged, typically requiring 4-6 months for union, particularly for proximal pole injuries, owing to the bone's tenuous where up to 80% of the intraosseous supply is from distal branches. rates range from 10-15% overall, rising to 30-50% for proximal pole fractures if untreated or managed conservatively, as can occur in the proximal fragment. Treatment depends on fracture stability and location. Stable, nondisplaced waist fractures (Herbert Type A or B2 without displacement) are initially managed conservatively with thumb spica casting for 8-12 weeks, achieving rates of approximately 90% in compliant patients. Unstable fractures (Herbert Type B with displacement, proximal pole, or comminuted), especially those at risk of , require surgical intervention, typically or open and using a headless compression screw such as the Herbert screw, which yields rates exceeding 90% and allows earlier mobilization. For proximal pole fractures, vascularized may be necessary in addition to fixation to promote healing.

Associated disorders

Avascular necrosis of the scaphoid, often referred to as Preiser's disease when idiopathic, arises from disruption of the bone's retrograde blood supply, predominantly affecting the proximal pole and leading to fragmentation and collapse. In the context of fractures, avascular necrosis complicates 13% to 30% of cases, with higher rates in proximal pole injuries due to limited vascularity entering from the distal end. Symptoms include progressive radial-sided wrist pain and reduced motion, diagnosed via MRI showing bone marrow edema or sclerosis without initial fracture evidence on radiographs. Treatment ranges from immobilization and NSAIDs for early stages to revascularization or salvage procedures like proximal row carpectomy in advanced collapse. Scaphoid non-union occurs in 5% to 25% of fractures, with rates of 5-10% after and up to 25% after , and manifests as hypertrophic (fibrous, stable) or atrophic (osteoporotic, unstable) variants that predispose to carpal . Risk factors encompass exceeding 1 mm, older age, and , with untreated non-union promoting progressive deformity and . Diagnosis relies on serial radiographs demonstrating lack of bridging , supplemented by for fragment assessment or MRI to detect concurrent . Management involves and to restore alignment and vascularity, preventing long-term complications like . Scapholunate dissociation stems from rupture of the , resulting in abnormal scaphoid palmar flexion and lunate dorsal extension, termed dorsal intercalated segment instability (DISI) deformity, which alters carpal and load distribution. This , common in 10-30% of intra-articular distal fractures, presents with dorsoradial pain, clicking, and weakness exacerbated by grip or loading activities. Radiographic signs include a scapholunate gap greater than 3 mm on posteroanterior views ( sign) and a scapholunate angle exceeding 70° on lateral views; confirms integrity. Chronic cases evolve into scapholunate advanced collapse (SLAC), a degenerative pattern initiating at the radial styloid and progressing to the midcarpal , often managed with or four-corner for pain relief and stability. Scaphoid shift syndrome describes dynamic instability arising from partial scapholunate ligament tears, where the scaphoid subluxates dorsally under radial deviation stress, eliciting and a palpable clunk on the scaphoid shift test (Watson's maneuver). This condition reflects early, motion-dependent carpal malalignment without static deformity, commonly following hyperextension trauma, and risks progression to static dissociation if untreated. involves provocative testing and dynamic to visualize , with treatment favoring ligament repair or dorsal capsulodesis to restore stability and avert . Post-traumatic involving the scaphoid typically develops as scaphoid non-union advanced collapse (SNAC), a sequential degenerative process starting at the radioscaphoid due to non-union and hinging of the proximal fragment. In SNAC, arthritis advances to the scaphotrapezial in later stages, causing stiffness, weakness, and pain with radial deviation, confirmed by radiographs showing space narrowing and subchondral sclerosis. Salvage options include radial styloidectomy for early involvement or four-corner with scaphoid excision for advanced to preserve motion while eliminating painful articulations.

Diagnosis

Diagnosis of scaphoid bone issues typically begins with a clinical focused on eliciting tenderness and assessing stability. Tenderness in the is a key indicator of , demonstrating high sensitivity of up to 100% but low specificity of around 9-74%, which can lead to overdiagnosis of non-fracture injuries. The scaphoid shift test, also known as the test, evaluates for by applying dorsal pressure to the scaphoid with the in radial deviation; a positive test, indicated by a clunk or pain upon ulnar deviation, has a sensitivity of 50-67% and specificity of 67%, performing better for more severe ligament disruptions. The , a palpable triangular on the radial aspect of the , serves as a primary landmark for and is bounded medially by the of the extensor pollicis longus, laterally by the tendons of the extensor pollicis brevis and abductor pollicis longus, and proximally by of the . Additional sites include the scaphoid tubercle on the palmar aspect, palpated with the in ulnar deviation. Initial imaging relies on plain radiographs, including , lateral, and dedicated scaphoid views with the wrist in ulnar deviation and 20-30° extension, though approximately 20-22% of fractures remain on these initial films due to the bone's orientation and subtle . For suspected fractures or , (MRI) is the gold standard, offering sensitivity of 88-100% and specificity up to 100% for detecting both fractures and early vascular compromise without . (CT) excels in assessing fracture , , and fragment with high , particularly useful in preoperative . Advanced diagnostic tools include , which evaluates bone viability and detects occult fractures with high sensitivity by showing focal tracer uptake, though it is less specific and involves radiation. Wrist arthroscopy provides direct visualization of ligament integrity and cartilage damage, confirming scapholunate dissociation or other intra-articular when non-invasive imaging is inconclusive. Diagnostic challenges arise from the scaphoid's intra-articular position and limited blood supply, with 15-22% of fractures missed on initial X-rays, necessitating clinical follow-up and repeat imaging at 10-14 days to reveal resorption lines or progression. This delay underscores the importance of for suspected cases pending confirmatory tests to prevent complications like .

Etymology and comparative anatomy

Etymology

The term "scaphoid" for the carpal bone derives from the σκάφος (skáp̄hos), meaning "" or "," reflecting its characteristic boat-like shape when viewed from the side. This etymology emphasizes the bone's , elongated form, akin to a small , a descriptor rooted in classical observations of its . Historically, the bone was referred to in Latin as "os naviculare" or simply "naviculare," from "navicula," diminutive of "navis" meaning "ship" or "little boat," highlighting a similar nautical theme in . This alternative name persisted into early modern but was phased out to avoid confusion with the tarsal in the foot. The scaphoid was first systematically described among the eight in the 2nd century AD by the physician in his anatomical treatises, where he detailed the wrist's skeletal structure. In the 19th and early 20th centuries, standardized nomenclature solidified the use of "scaphoid" (Latinized as "os scaphoideum") through efforts like the Basle Nomina Anatomica (1895) and subsequent revisions, such as the Paris Nomina Anatomica (1955), which reserved "navicular" exclusively for the pedal bone. The etymology remains confined to anatomical contexts, with no notable cultural or symbolic extensions beyond this descriptive origin.

In animals

In mammals, the scaphoid bone is homologous to the radial carpal bone, serving as the medialmost element in the proximal row of the carpus and often displaying a boat-shaped form in and carnivores to support comparable mobility across these groups. This central positioning allows it to articulate proximally with the and distally with elements of the distal carpal row, contributing to the overall stability and in the . Structural variations in the scaphoid homologue are evident across , reflecting adaptations to diverse locomotor demands; in ungulates such as , the radial carpal bone incorporates a fusion of the scaphoid and lunate, while the adjacent intermediate carpal bone derives from the os centrale, resulting in a more streamlined carpus suited to high-speed . In contrast, arboreal like monkeys exhibit a more elongated scaphoid to facilitate grasping and suspension, enhancing proximal-distal mobility during climbing. These differences underscore the bone's evolutionary plasticity in response to positional behaviors. Functionally, the scaphoid homologue acts as a primary load-bearing structure in quadrupeds, such as , where it transmits through the carpus during weight-bearing phases of . In , it supports enhanced flexion and extension, paralleling dynamics to accommodate varied arboreal and terrestrial activities. Evolutionarily, the scaphoid traces its origins to the distal radial elements in the pectoral fins of Devonian fishes, which underwent transformation into discrete carpal ossifications in early tetrapods to enable on . In , fractures of the radial carpal bone are prevalent in racing horses due to repetitive stress, commonly managed through with splints or bandages to promote healing and prevent further displacement.

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