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The scaphoid bone contains few blood vessels, making its recovery from injury slow. If the break did not dislocate bone fragments during fracture, your doctor can treat it using a splint or cast.
For more severe fractures, your doctor may use internal fixation surgery. This involves implanting metal screws and pins through an incision made in your wrist.
Treatment of Scaphoid Fracture
Scaphoid fractures warrant treatment, which can be either surgical or nonsurgical, contingent on the fracture’s severity. The best approach hinges on the fracture’s location and extent. The following are common treatment options for scaphoid fractures:
Nonsurgical Treatment:
- Cast or Splint: If the fracture isn’t displaced, a cast or splint suffices. Wearing it for around 6 months or until healing is common.
- Immobilization: The broken bone necessitates healing; this is achieved through a cast, splint, or brace, contingent on the extent and cause of the fracture.
Surgical Treatment:
- Internal Fixation: Surgery becomes necessary for displaced fractures, particularly at the waist or proximal pole. Realignment and stabilization via surgery improve the healing prospects. Surgeons employ internal fixation—placing metal pieces to secure the bone in its proper position for healing.
- Bone Grafting: If severe displacement or inadequate healing is observed, bone grafting may be needed. Additional bone tissue is introduced to facilitate rejoining.
It’s vital to remember that scaphoid fractures heal gradually. During recovery, unless authorized by a physician, wrist use should be limited.
X-rays
Doctors may fail to detect scaphoid fractures on initial X-rays due to its ability to pass off as just another wrist sprain; thus it is essential that anyone who falls experience their wrist checked after thinking they may have just sprained it.
Scaphoid fractures that do not displace typically heal well with proper treatment and immobilization in a splint, while those with displace fractures may require special consideration to heal properly due to nonunion – an important aspect that can cause long-term pain and wrist stiffness.
Under surgical treatment, your physician will make an incision on either the front or back of your wrist to reposition and secure the scaphoid bone with screws and wires. He may also insert a piece of bone called a bone graft to facilitate its healing.
Casting
Most scaphoid fractures with limited displacement can be treated effectively by casting the wrist. However, due to retrograde blood supply to the scaphoid bone, fractures in its proximal pole may pose greater risks of nonunion and avascular necrosis than fractures elsewhere on its surface.
Physical examination of the wrist and thumb will involve testing for pain, swelling, bruising and range of motion issues. One area that should be scrutinized specifically is known as “anatomic snuff box”, as this boney prominence directly over the thumb side of the wrist should be assessed for discomfort.
Untreated scaphoid fractures often result in arthritis in the wrist due to insufficient bloodflow reaching the bone, eventually leading to cell death and collapse of its structure. A vascularized graft may provide additional blood flow directly into the shaft of scaphoid bone for effective treatment; simply place this into its shaft to restore blood supply to this region of bone.
Bone stimulator
Non-displaced scaphoid fractures often heal without surgery, particularly those in the distal third of the bone which often result from falls on outstretched hands and are sometimes even completely painless.
Your doctor will evaluate the severity of your scaphoid fracture with a physical exam and imaging tests, including an x-ray to show whether or not its location has changed, such as whether a broken bone has dislodged from its place in bone. If displaced fractures exist, healthcare providers may suggest immobilization using casts in order to limit thumb movement.
Scaphoid fractures don’t always show up on an X-ray, in which case your doctor may request either a bone scan or CT scan to better visualize the break and detect nonunion or Avascular Necrosis (AVN), a condition characterized by decreased blood supply to a broken bone, which a scaphoid fracture could aggravate by not receiving treatment immediately.
Surgery
Scaphoid fractures may be fairly prevalent, yet can be hard to detect. According to one study, initial radiographs were only 86% sensitive at identifying non-displaced scaphoid fractures.
If a displaced scaphoid fracture requires surgery to realign and improve chances for healing, open reduction and internal fixation (ORIF) may be recommended as part of treatment plan. This process is known by acronym.
At this operation, a screw is implanted into the bottom piece of broken scaphoid bone to reconnect it and direct blood flow around it. It will remain in place throughout the patient’s lifetime.
In most cases, surgeons can perform this surgery through minimal incisions; however, if the scaphoid has significant displacement at its waist or proximal pole, a larger incision may be necessary for adequate exposure and screw placement. Furthermore, bone graft (new bone) may be used in these instances to promote fracture healing.
How Long Does It Take for a Scaphoid Fracture to Heal
Healing time for a scaphoid fracture hinges on severity and treatment method. Here are estimations based on different approaches:
- Non-Surgical Approach: Non-displaced fractures respond well to casts or splints. Distal pole fractures mend within around 6 weeks, while other scaphoid fractures can take 10-12 weeks for full healing in uncomplicated cases.
- Surgical Approach: Waist or proximal pole fractures or displacement may necessitate surgery. Healing post-surgery can span up to 12 weeks if treated promptly or even extend to six months if diagnosis is delayed.
Crucially, healing time varies with fracture specifics, like location, displacement degree, and prior treatment.
Furthermore, a fracture line might take up to two weeks to manifest on plain films, especially for non-displaced fractures. Regular doctor visits are essential to track healing progress and adjust treatment plans as needed.
What Are the Risks of Surgery for a Scaphoid Fracture
Surgical intervention for scaphoid fractures entails inherent risks, akin to any surgical procedure. Potential complications include:
- Stiffness: Post-surgery, wrist or hand stiffness might restrict motion range.
- Infection: Surgical procedures carry infection risk, scaphoid fracture surgery included.
- Nerve Damage: Surgery poses a nerve injury threat, possibly causing hand or finger numbness, tingling, or weakness.
- Hardware Complications: Surgical hardware, like screws or plates, can incur problems such as loosening or breakage.
- Bone Healing Failure: Despite surgery, improper bone healing (nonunion) remains a risk.
Engaging in a thorough discussion with your doctor is essential, outlining potential benefits and risks of surgery. Thoughtful consideration of options is crucial. In select cases, non-surgical treatment via casts or splints could offer a comparably safe and effective alternative.
What Is the Success Rate of Non-surgical Treatment for a Scaphoid Fracture
Success rates of non-surgical treatment for scaphoid fractures differ by fracture severity and treatment. Success estimations based on studies are as follows:
- An 89% success rate was found in a multi-center cohort study for acute non-displaced scaphoid fractures treated non-operatively.
- Distal scaphoid fractures often heal within 4 to 6 weeks with conservative treatment.
- Scaphoid non-union incidence ranges from 5% to 15%. Surgical intervention can restore blood supply and stabilize non-unions.
- Adequate screw fixation yields a 95% successful union rate for acute scaphoid fractures, using both palmar and dorsal approaches.
Importantly, each scaphoid fracture’s uniqueness impacts success rates, considering fracture location, displacement, and patient compliance with immobilization.
Surgery might become necessary if non-surgical treatment falters or fractures are severe. Hence, discussing potential benefits and risks with your doctor and meticulous consideration of options is paramount before deciding.
