Our Summary

This research paper is about a 30-year-old man who had a 15-year-old fracture in a small bone in his wrist (the scaphoid) that hadn’t healed properly, causing his wrist to collapse. This is a common issue that can lead to arthritis-like changes in the wrist. The man didn’t have any signs of bone death due to lack of blood supply (avascular necrosis). The original injury happened when he fell onto his hand.

The doctors treated him by opening up his wrist, putting the bone back in place, securing it with internal fixings, and adding in some bone from his hip to help it heal. A year later, the man’s wrist was working well and he had good grip strength. A CT scan confirmed that the fracture had healed.

Usually, if more than five years pass between the original fracture and treatment, the chances of the bone healing properly drop dramatically. But in this case, even though it had been 15 years since the injury, the man’s wrist healed well and function returned.

FAQs

  1. What is scaphoid non-union and how does it affect wrist function?
  2. What is the risk of not treating a scaphoid fracture within 5 years of the initial injury?
  3. What is the procedure for treating a scaphoid fracture with secondary scaphoid non-union advanced collapse?

Doctor’s Tip

One helpful tip a doctor might tell a patient about scaphoid fracture surgery is to seek treatment as soon as possible to improve the chances of successful healing and return of function. Delaying surgery can decrease the likelihood of a successful outcome, so it is important to address the issue promptly to prevent further complications. Additionally, following post-operative care instructions, attending follow-up appointments, and participating in physical therapy are essential for a full recovery.

Suitable For

Patients who are typically recommended scaphoid fracture surgery include those with:

  • Symptomatic scaphoid non-union
  • Advanced collapse of the wrist joint
  • No evidence of avascular necrosis
  • History of a fall onto an outstretched hand
  • Long duration between initial fracture and treatment exceeding 5 years

It is important to note that each case is unique and the decision to undergo surgery should be made in consultation with a healthcare provider based on the individual patient’s specific circumstances and needs.

Timeline

Before scaphoid fracture surgery:

  • Patient sustains a fall onto an outstretched hand, resulting in a scaphoid fracture.
  • Initial injury may be followed by symptoms such as pain, swelling, and limited wrist movement.
  • Due to delayed diagnosis or non-treatment, scaphoid non-union may develop, leading to advanced collapse of the wrist joint.
  • Patient may experience worsening symptoms and decreased wrist function over time.

After scaphoid fracture surgery:

  • Patient undergoes scaphoid open reduction, internal fixation, and bone graft surgery to promote healing and restore wrist function.
  • Following surgery, patient undergoes a period of immobilization and rehabilitation to allow for proper healing and recovery.
  • Over the course of several months to a year, patient experiences gradual improvement in wrist function, grip strength, and reduction of symptoms.
  • Follow-up imaging, such as CT scans, confirms union of the fracture and successful outcome of the surgery.
  • Despite the long duration between initial injury and surgery, patient achieves good return of function and avoids long-term complications associated with scaphoid non-union.

What to Ask Your Doctor

  1. What specific type of scaphoid fracture surgery will be performed in my case?
  2. What is the expected outcome of the surgery in terms of pain relief and wrist function?
  3. What is the typical recovery time and rehabilitation process after scaphoid fracture surgery?
  4. Are there any potential risks or complications associated with the surgery that I should be aware of?
  5. Will I need a bone graft as part of the surgery, and if so, where will the bone graft be taken from?
  6. How soon after the surgery will I be able to return to normal activities or sports?
  7. Will I need physical therapy after the surgery, and if so, how long will I need to continue with it?
  8. What is the long-term prognosis for my wrist after scaphoid fracture surgery?
  9. Are there any alternative treatments or procedures that I should consider before opting for surgery?
  10. How often will I need follow-up appointments to monitor my recovery and healing progress?

Reference

Authors: Wong KY, Sharp O, Johnston P. Journal: BMJ Case Rep. 2018 Jan 4;2018:bcr2017221615. doi: 10.1136/bcr-2017-221615. PMID: 29301797