Our Summary

This research paper looks at a bone condition called scaphoid nonunion, which, if left untreated, can worsen and require complex medical procedures. The paper discusses various methods of treating this condition, and highlights that a technique called vascularized bone flaps (VBFs) has shown to be successful. VBFs involve using local bone flaps, which are pieces of bone with blood supply, to promote healing. This method doesn’t require complicated microsurgery and should be a tool all hand surgeons know how to use. When the right patients are chosen for this procedure, the success rate is extremely high, ranging from 90% to 100%.

FAQs

  1. What are the potential risks if a scaphoid nonunion is left untreated?
  2. What is the success rate of achieving union using local Vascularized Bone Flaps (VBFs) in treating scaphoid nonunion?
  3. What advantages do Vascularized Bone Flaps (VBFs) offer over nonvascularized grafts in treating scaphoid nonunion?

Doctor’s Tip

One helpful tip a doctor might tell a patient about scaphoid fracture surgery is to follow the post-operative care instructions carefully, including keeping the affected hand elevated and immobilized as directed. This can help promote proper healing and reduce the risk of complications. Additionally, attending follow-up appointments with your doctor and participating in physical therapy as recommended can aid in your recovery and improve your overall outcome.

Suitable For

Patients with scaphoid nonunion, particularly those at risk for scaphoid nonunion advanced collapse, are typically recommended scaphoid fracture surgery. Additionally, patients with scaphoid fractures that have not healed with non-surgical treatments such as casting or immobilization may also be candidates for surgery. Patients with displaced or unstable scaphoid fractures, as well as those with avascular necrosis of the scaphoid, may also be recommended for surgery to improve healing and prevent long-term complications.

Timeline

  • Patient experiences wrist pain and swelling after a fall or injury
  • Patient seeks medical attention and undergoes physical examination and imaging studies (X-rays, MRI) to diagnose scaphoid fracture
  • Patient is placed in a cast or splint to immobilize the wrist and allow the fracture to heal
  • If the fracture does not heal with conservative treatment, patient may be recommended for scaphoid fracture surgery
  • Surgery involves open reduction and internal fixation (ORIF) with screws or pins to stabilize the fracture
  • Patient undergoes postoperative rehabilitation and physical therapy to regain wrist function and strength
  • Follow-up appointments with the surgeon are scheduled to monitor healing and remove hardware if necessary
  • Patient gradually returns to normal activities and may experience improved wrist function and pain relief after surgery.

What to Ask Your Doctor

  1. What type of scaphoid fracture surgery do you recommend for my specific case?
  2. What are the potential risks and complications associated with the surgery?
  3. How long is the recovery period after the surgery?
  4. Will I need physical therapy or rehabilitation after the surgery?
  5. What is the success rate of this type of surgery for scaphoid fractures?
  6. How soon can I return to my normal activities after the surgery?
  7. What type of anesthesia will be used during the surgery?
  8. How many of these surgeries have you performed in the past?
  9. What are the alternative treatment options to surgery for my scaphoid fracture?
  10. Are there any specific precautions or restrictions I should follow before or after the surgery?

Reference

Authors: McCarty JC, Hamaguchi R, Eberlin KR. Journal: Hand Clin. 2024 Feb;40(1):117-127. doi: 10.1016/j.hcl.2023.08.004. Epub 2023 Sep 15. PMID: 37979983