Commentary: Scaphoid Fracture in an Elite or Professional Baseball Player

Abstract

ic s. co m A scaphoid fracture in a baseball player can affect hitting, throwing, and training. This injury usually results from a fall on the outstretched hand in a game, during practice, or when out and about. Although the pain is often too severe to permit hitting or throwing, the pain is more subtle at times and manifests as weakness with all baseball activities. One player had pain only while swinging in the batter’s box but not at the plate. Players also have pain when working out while doing any weight-bearing exercise and lifting free weights, particularly wrist curls. Once the athlete brings the discomfort to the attention of the medical staff, radiographs, computed tomographic (CT) scans, and, if obscure, magnetic resonance images are obtained. Recently, a player with a tender scaphoid, minimal pain with weight bearing, and normal radiography results was diagnosed using magnetic resonance imaging as having a nondisplaced but complete scaphoid waist fracture. Our general approach is to place a screw in the nondisplaced (or displaced) scaphoid fracture through a dorsal approach. Two to three days after surgery when off narcotics for 24 hours, general rehabilitation is begun with aerobic work and lower body strengthening. We prefer a really rigid splint (EXOS) or molded well-fitting orthoplast splint during the rehabilitation part of the postoperative care. This is removable and so gentle wrist and forearm range of motion can begin. If motion is too painful for the patient, then a short arm thumb spica cast is used until the patient is comfort-