Scaphoid bone fracture

Scaphoid bone fracture occurs normally when a person falls on an outstretched hand. With the palm bearing the weight, there is the risk of forearm bone (distal radius) fracture too. The symptoms are pain and swelling in the wrist. If there is no deformity of the wrist, people generally tend to think that it is only a sprain. If symptoms like pain and swelling on the thumb side of the wrist after a fall last a few days, then it is advisable to see a doctor and get treated for the broken bone. Located where the wrist bends towards the thumb, Scaphoid bone is at the base of the small depression made by the thumb tendons. When the Scaphoid is injured, pain or tenderness is associated with it.

Consult a doctor if the pain on the thumb side of the wrist persists even after few days of medication. The orthopaedist will prefer to take X-rays, but sometimes a broken bone of this type does not show up clearly on an X-ray. A MRI helps in confirming scaphoid bone fracture. Minimize the risk of broken bones around the wrist by using wrist guards while performing activities like snowboarding and inline skating.

Depending on the location of the break in the bone, an orthopaedist starts the treatment. If it is broken at the end near the thumb which has good blood supply, healing takes place within a few weeks if it is protected properly. A CT scan or X-ray will confirm that the fracture has healed. A cast that may or may not include the thumb is a good option to heal this kind of Scaphoid fracture. If the Scaphoid is broken in the middle or at the proximal pole which does not have good blood supply, it is difficult to heal. The doctor places a cast that includes the thumb and index finger and extends up to the elbow.

In some cases, wrist arthritis may develop following a Scaphoid fracture. This may be due to the cartilage injury at the time of the fall or accident, or due to wear and tear from changes in the alignment of the joints. It may also be due to a cut off in blood circulation. Deterioration of the bone (avascular necrosis) at this part will lead to degenerative arthritis. Physiotherapy exercises and special exercises will improve movement and strength of the Scaphoid bones. Stiffness in the wrist and finger is not unusual after this injury.

Colles fracture

A very common bone fracture that occurs in patients under 65 years of age, Colles fracture injures the wrist bone of the patients. Older patients normally sustain hip fractures. The most common type of broken wrist is one in which the larger forearm gets broken near the wrist. This fracture is noticed when a patient falls with an outstretched hand. The wrist joint of the patient is displaced and it rests behind its usual anatomic position. Accidents like car accident, a bike accident or similar situations can lead to Colles fracture. When the ulna (the other forearm bone) is broken, it is called a distal ulna fracture. The fracture is named after an Irish surgeon and anatomist, Abraham Colles in 1814 who first described it.

The doctor usually describes a wrist fracture by radius. This means that the patient has sustained a fracture in one of the two forearm bones. There may be other types of fractures one can sustain near the wrist, but when the end of the forearm bone is broken it is a wrist fracture or Colles fracture. When pain is associated in the wrist joint after an injury, a wrist fracture is suspected. There are typical symptoms of a wrist fracture such as wrist pain and deformity of the wrist. Normally the fracture is about 1 inch from the end of the bone. When the fracture extends into the joint, it is called an intra-articular fracture. This kind of fracture is more difficult to treat.

A primary care physician reviews the X-rays to determine the proper position of the fracture and assesses the stability of the broken bone structure. The area of the wrist is amenable for cast treatment and most of the Colles fracture patients can be treated using casts. For fractures in which the bones are out of proper position, a doctor can reset the fracture with local anesthesia or under light sedation. This procedure is known as reducing a wrist fracture. Only an orthopedist can determine if surgery is necessary. Various considerations like the abnormality of the wrist angle or the degree of shortening of the forearm bone are kept in mind before going for treatments like casting or surgery. If there is minimal shortening or displacement, casting is sufficient. Operative treatment is necessary if the injury is more significant.One can prevent Colles fracture by maintaining good bone health and by avoiding osteoporosis and falls. Older people should take extra care to keep their balance and prevent falls.

Bone cancer

Bone tumor is an abnormal growth of cells within a bone. Bone tumors may be malignant or benign. Though the causes of bone tumors are unknown, some possible causes include hereditary or genetic defects, radiation and injury. In most cases, no specific cause is found. Osteochondromas is a most common non cancerous bone tumor which occurs in people between ages ten and twenty. While primary bone cancers start from bones, secondary or metastatic bone tumors start in another part of the body such as breast, kidney, lung, prostate and thyroid and spread. These forms of cancer usually affect older people.

Symptoms of bone cancer

Some common bone cancer symptoms include:

• Bone fracture or fracture from slight injury or trauma.
  
• The most common symptom of bone cancer is pain. Though mild initially, bone pain gradually becomes intense and tends to worsen at night.
  
• A mass or lump may be felt on the bone or the tissues surrounding the bone. This is common with fibrosarcoma.
  
• Bones become weakened by tumor and may lead to a fracture. This can occur with both benign and malignant tumors.
  
• Mass swelling at the tumor site which may be occasionally found.
  
• Pain, numbness and tingling in the extremities can be found if tumor is compressed and this can affect the blood flow to the extremities.
  
• Fever, chills and night sweats can occur though these are less common signs.
  
• Weight loss can occur in some cases.
  

Diagnosis of bone cancer

After taking into account the complete medical history and performing a physical examination, the following diagnostic tests would be done.

• Alkaline phosphatase blood test.
  
• CT scan can give a cross sectional picture of the bones and additional information on the size and location of the tumor.
  
• MRI of the bone and surrounding tissues can provide cross sectional imaging of the body and better details of soft tissues, including muscles, tendons, ligaments, nerves and blood vessels.
  
• X ray of the bone and surrounding tissues.
  
• A bone scan is taken on the entire body and is not specific for any type of tumor.
  
• Bone biopsy: When the tumor is identified, the doctor may then obtain a biopsy sample of the tumor. This involves taking a small sample of the tumor and examining it in the laboratory by a pathologist. This biopsy can be obtained through a small needle or through a small incision.
  

Treatment of bone cancer

There are many treatment options for bone cancer depending upon the type of bone cancer and the location of the cancer. It also depends on whether or not the cancer has spread from the bone to surrounding tissues. Treatment options include surgery, chemotherapy and radiation therapy. These can be used individually or in combination with each other.

Although some benign bone tumors tend to go away on their own and hence do not require treatment, close monitoring is essential to see if the tumor shrinks or grows. In case of malignant tumors, surgery would become essential. The goal of surgery is to remove the entire tumor and its surrounding area or normal bone. A pathologist examines the tumor once removed to determine if there is normal bone completely surrounding the tumor. In case the cancer is left behind, chances are it can continue to grow and spread requiring further treatment.

Depending upon the size/amount of bone removed, the surgeon will replace either by bone cement or bone graft from another place in the body or from the bone bank. For larger areas, larger grafts from the bone bank or metal implants are done. Historically, amputation was the technique used to remove bone cancer. However, new techniques adopted have significantly decreased the need for amputation. Treatment for cancers that spread from other parts of the body would depend upon where the cancer started.