A decreased range of movement may be observed by the doctor. Particularly lack of extension, putting the heels of the hand together and cocking the wrist back will show any asymmetry. The scaphoid is a boat-shaped bone. Fractures can occur anywhere along its length, but the vast majority over three-quarters occur through the centre of the scaphoid waist.
The site of the scaphoid fracture has significant impact on the healing potential. However, fractures towards the wrist joint the so-called proximal pole fractures have an increased risk of the fracture not uniting. This is on account of poorer blood supply to this area of bone. Other risk factors for developing a non-union i. Plain x-rays are the most common way to diagnose a scaphoid fracture.
It can be seen as a line across the scaphoid bone. However, scaphoid fractures occasionally do not show up on the initial x-ray, and in this case if your doctor strongly suspects you have fractured your scaphoid you may be treated in a plaster of Paris, and a repeat x-ray performed in one week. Some fractures of the scaphoid can be treated in a plaster cast. These are usually the fractures through the waist, which are undisplaced.
However, scaphoid fractures that are displaced i. Scaphoid fractures that are treated non-operatively usually involve a plaster of Paris immobilisation for a period of six to twelve weeks. Careful x-ray, follow up and CT scanning may be required to ensure the fracture has united. Scaphoid fractures that occur in the proximal pole or scaphoid fractures that are displaced often require operative treatment.
Surgery is performed under general anaesthetic or regional anaesthesia only the arm is made numb. Please see our pain management form for more detailed information on how to avoid pain, nausea and constipation. If the incision is red or if there is drainage coming out of it, please call us right away at the phone number listed at the bottom of this page. Go to the emergency room if this occurs at a night or on a weekend. Scaphoid fractures or nonunions are very critical injuries.
If your fracture does not heal, there is a risk of developing arthritis. By using both internal fixation and bone grafting for nonunions or internal fixation alone for acute injuries , most patients recover almost full motion and strength.
It may take months after the first surgery for this amount of recovery to occur. Trumble, MD, Ghazi M. Rayan, MD, Mark E. Baratz, MD and Jeffrey E. Budoff, MD.
Thomas Trumble, M. Made by Digital Laboratory. After reviewing symptoms and examining for physical signs, the physician will order a set of X-rays, and possibly additional imaging tests such as a bone scan, computed tomography CT , or magnetic resonance imaging MRI.
An acute scaphoid fracture. Sagittal reformatted computed tomography CT scan shows a fracture through the mid waist of the scaphoid arrow. Three dimensional 3D reformatted images produced from high resolution CT scanners are often helpful in surgical planning. MRI of a scaphoid fracture. Since around , there has been an increased awareness among primary care physicians, pediatricians, and general orthopedists in early diagnosis and treatment of scaphoid fractures in order to prevent nonunion and generalized wrist arthritis.
However, patients should also be vigilant and knowledgeable about scaphoid fractures if they have experienced — or are at risk of experiencing — trauma to the hand or wrist.
In concert with that change in philosophy has been a series of improvements in surgical equipment and techniques. Casting, however, remains a safe and effective option for healing in many cases. One challenge of treating scaphoid fractures is their lengthy healing time. The peculiarity of its blood supply is the primary reason for this prolonged healing period.
Whereas other fractures in the upper extremity require an average of six weeks, a scaphoid fracture requires an average of 12 weeks if treated immediately, and as long as six months if the diagnosis is delayed. Determining factors include the location of the fracture, the degree of displacement misaligned bone ends , and failure of prior treatment. The two main treatments for scaphoid fractures are casting and surgery, and the indications and expected results are explained in greater detail as follows:.
Displaced fractures or highly complicated fracture patterns usually require an operative approach to realign the fracture fragments and hold them together until healing. Fractures that have been determined to have lost blood supply may require a specialized type of surgery that employs transfer of a bone graft with a new blood supply.
As Dr. Still, complicated or displaced fractures of the scaphoid may not be amenable to this new approach. Successful internal fixation of a scaphoid fracture, which has essentially healed.
Because the incision is so small, a suture is usually not required. The hand is then held in a sterile cotton dressing and a plaster splint, which extends from the wrist to the midsection of the forearm.
Rehabilitation begins almost immediately after surgery. Ten days later, the dressing and splint is exchanged for a removable plastic splint. New techniques also can include the manipulation of displaced fractured fragments arthroscopically or under fluoroscopic control prior to placing the fixation screw. This sometimes enables percutaneous fixation of fractures that would have otherwise required open surgical treatment.
Despite the effective diagnostic and treatment options available today, Dr. Wolfe notes that he continues to see a high number of untreated scaphoid fractures that have progressed to nonunion. However, he adds that this may not be the result of a missed diagnosis, but rather more related to the relatively innocuous injury that causes a low level of suspicion.
Specialized imaging studies are critical at an early stage to reduce the chance of scaphoid nonunion. Image shows a chronic scaphoid fracture nonunion with osteoarthritic changes apparent in the adjacent joint.
When faced with a scaphoid nonunion, a physician is presented with many variables, including the tenuous blood supply to the scaphoid, the possibility of malposition of other bones, and degenerative arthritis.
The most difficult problems are related to the time elapsed since the injury. Although recent diagnostic and surgical advances have revolutionized treatment for scaphoid fractures, new innovations are currently being discovered and tested. Treatment: History and Physical Exam: The doctor or midlevel provider will obtain a history of the problem and perform an appropriate physical exam to find the area of concern. Imaging: Usually, imaging of the wrist begins with x-rays. If more information is needed, the doctor or midlevel provider may order a CT scan or an MRI of the wrist.
Surgery: The goal of treatment is for the Scaphoid fracture to heal with an adequate blood supply to the entire bone. Options for surgical treatment include placing a screw in the bone to realign and support the fracture. Bone graft may also be used to aid in fracture healing. Pre-operative Care: If you have pain in the thumb side of the wrist after a recent fall, you should seek immediate medical attention from a doctor or midlevel provider who is familiar with Scaphoid fractures.
If left untreated, a Scaphoid fracture may lead to a fracture non-union which can put you at risk for developing wrist arthritis.
If a decision for surgery is made after seeing one of our Orthopaedic Hand Surgeons, you may require pre-operative medical clearance by our Anesthesia department or your Primary Care Provider.
This depends on your other medical conditions.
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