Scaphoid Fracture Fixation
A scaphoid fracture, one of the most common types of wrist fractures, is a break in the scaphoid bone. The scaphoid, one of the most important bones in the wrist, has a limited blood supply. An improperly treated scaphoid fracture can result in significant wrist pain, arthritis, and loss of motion.
The scaphoid is one of the bones that make up the wrist. It is found near the thumb on the side of the wrist. A scaphoid fracture most frequently occurs from falling on an outstretched hand, with the force of the impact directly involving the palm.
Scaphoid fractures may occur at any age, though they are most common in men between the ages of 20 and 30. Often, the injury takes place while playing a sport or in a motor vehicle accident. To treat the fracture, a fixation of the bone may be needed. Scaphoid fracture fixations can either be surgical or non-surgical, depending on the location of the break in the bone.
Diagnosis of a Scaphoid Fracture
Scaphoid fracture fixation may be recommended for patients with pronounced pain or swelling at the base of their thumb. This pain typically becomes more severe with movement of the thumb or wrist. However, since the outward appearance of the wrist is usually unaffected, the symptoms may be misidentified as a wrist sprain. If the pain has not resolved the day after the injury, a scaphoid fracture should be suspected.
The doctor will perform a physical examination of the affected wrist. X-rays may be taken to determine whether the scaphoid bone has been fractured, and if there are any gaps created by the broken bone. In some cases, a broken scaphoid may not be visible on an X-ray image. If the fracture is indeterminable from the X-ray, an MRI scan may be recommended. This can provide a clear view of the bones and soft tissues of the wrist and may indicate a scaphoid fracture.
Scaphoid Fracture Fixation Treatment Options
Scaphoid fracture fixation may be surgical or nonsurgical, depending on the location of the break in the bone. A scaphoid fracture that has occurred closer to the thumb will usually heal after several weeks with the patient wearing a cast on the affected arm and hand. That portion of the scaphoid has a plentiful blood supply, which improves the healing process. If the scaphoid fracture occurs closer to the middle of the bone, toward the forearm area, healing may not take place as quickly. This portion of the scaphoid does not have as good of a blood supply. A cast may still be used to achieve fixation, and it will likely cover part of the thumb as well as the hand and arm.
If the scaphoid bone fails to heal with the use of a cast to stabilize it, surgical scaphoid fracture fixation may be necessary. This is especially common in those patients with a fracture closer to the forearm area.
During a scaphoid fracture fixation procedure, an incision may be created at the front or back of the wrist, depending on the location of the fracture. The surgeon will use metal instrumentation, such as screws and wires, to maintain the correct positioning of the scaphoid bone until it has fully healed.
Sometimes, a scaphoid fracture will result in the bone being broken into more than two pieces. If that is the case, a bone graft may be necessary to achieve complete healing. The graft material may be obtained from the patient's forearm bone or from the hip. The bone graft incorporates this additional bone material around the broken scaphoid in order to promote healing and greater production of healthy bone.
Recovery from Scaphoid Fracture Fixation
Whether or not a scaphoid fracture requires surgery, the patient will need to wear a cast or splint until the fracture heals. While the healing time varies by patient, a complete recovery may take up to 6 months. During the recovery period, patients should avoid lifting heavy objects and are restricted from participating in any contact sports. During a follow-up appointment, X-ray or CT imaging scans will be used to confirm that the scaphoid bone has healed. Some patients may also need to undergo physical therapy to restore strength and flexibility in the wrist.
Risks of Scaphoid Fracture Fixation
Following surgical or nonsurgical scaphoid fracture fixation, patients often experience stiffness in the injured wrist. This is especially common when a cast had been worn for a long period of time, or when the fracture required extensive surgery. Even after a course of physical therapy, however, some patients may never regain the same wrist strength they had prior to the fracture.