Our Summary

This research looked at data from 806 patients in the UK who had surgery for a non-healing fracture in their scaphoid, a small bone in the wrist. The study was conducted across 19 medical centers, each contributing a minimum of 30 cases. The researchers were able to study 462 cases in detail to understand what factors could influence the success of this surgery. They found that the surgery was successful, i.e., the bone healed, in 69% of the cases, while in 22% of the cases, the bone did not heal. The remaining 9% of the cases were unclear about whether the bone healed or not. The study found that smoking and the length of time between the initial fracture and the surgery seemed to negatively affect the success of the surgery. However, these factors did not reach the level of significance set for this study. The type of bone graft used in the surgery did not seem to impact the outcome. The researchers suggest that more extensive studies are needed to understand if changing the surgical technique can improve the success rate.

FAQs

  1. What factors were found to influence the outcome of scaphoid fracture surgery?
  2. Did the type of bone graft used in the surgery have any impact on the outcome?
  3. What percentage of patients achieved union after the surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about scaphoid fracture surgery is to quit smoking before the procedure, as smoking can negatively impact the healing process and increase the risk of nonunion. Additionally, it is important to undergo surgery for a scaphoid fracture nonunion in a timely manner to improve the chances of a successful outcome. It is also important to follow post-operative instructions carefully to promote proper healing and reduce the risk of complications.

Suitable For

Patients who are typically recommended scaphoid fracture surgery include those with a scaphoid fracture nonunion, particularly those who have not responded to conservative treatment options such as immobilization or casting. Factors that may influence the outcome of surgery include smoking, the time between the acute scaphoid fracture and nonunion surgery, and the type of bone graft used. Further large multicentre prospective studies are needed to clarify whether modification of surgical technique can influence union.

Timeline

  • Before surgery:
  1. Patient experiences a scaphoid fracture, which may be caused by a fall on an outstretched hand or other trauma.
  2. Patient may undergo initial treatment such as immobilization in a cast or splint.
  3. If the fracture does not heal properly, the patient may develop a scaphoid nonunion, leading to persistent pain and limited wrist function.
  4. Patient may experience symptoms such as swelling, tenderness, and difficulty gripping or moving the wrist.
  • After surgery:
  1. Patient undergoes bone graft surgery for the scaphoid nonunion, typically using bone from the iliac crest or distal radius.
  2. Recovery from surgery involves a period of immobilization in a cast or splint to allow the bone to heal.
  3. Physical therapy may be prescribed to help regain strength and range of motion in the wrist.
  4. Follow-up appointments with the surgeon are scheduled to monitor healing and address any complications.
  5. In most cases, the bone graft surgery results in union of the fracture, with the majority of patients experiencing improved wrist function and reduced pain.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with scaphoid fracture surgery?
  2. How long is the recovery process expected to take?
  3. What type of anesthesia will be used during the surgery?
  4. Will I need to undergo physical therapy after the surgery?
  5. What is the success rate of scaphoid fracture surgery in terms of achieving union?
  6. Are there any lifestyle changes or restrictions I should follow after the surgery?
  7. How soon can I return to normal activities, such as work or sports, after the surgery?
  8. Will I need to have any follow-up appointments or imaging studies to monitor the healing process?
  9. What type of bone graft material will be used in the surgery, and how does it affect the outcome?
  10. Are there any alternative treatment options to consider before proceeding with surgery?

Reference

Authors: Ammori MB, Elvey M, Mahmoud SS, Nicholls AJ, Robinson S, Rowan C, Spence S, Wade RG, Karantana A; British Society for Surgery of the Hand Scaphoid Nonunion Group; Davis TRC. Journal: J Hand Surg Eur Vol. 2019 Sep;44(7):676-684. doi: 10.1177/1753193419841278. Epub 2019 May 20. PMID: 31109228