Our Summary

This research paper discusses a case of a young student who broke both of his scaphoid bones (small bones in the wrist) after falling during a football game. Initially, only the break on his left wrist was diagnosed and treated, using a screw to hold the bone together.

Eight months later, the student came back to the hospital because of pain in his right wrist. It turned out that his right scaphoid bone had also been broken in the initial accident but was not diagnosed at the time because he did not report any pain. As a result of the delay in diagnosis, the bone had not healed properly, leading to a painful condition called non-union, where a fracture fails to heal.

The doctors then performed a surgical procedure to repair the right wrist. They used a screw to stabilize the bone and a piece of bone taken from the patient’s own radius (one of the bones in the forearm) to stimulate healing.

The study concludes that fractures in both scaphoid bones at the same time are quite rare, but when they occur, they are usually in athletes or manual laborers. If not treated properly, these fractures can lead to arthritis, deformity, and loss of function in the wrist. Therefore, doctors should be thorough in their imaging studies when they suspect a scaphoid fracture, even if the patient only reports mild symptoms.

In this case, the doctors recommend a follow-up X-ray about two weeks after the injury, even if the patient does not report any pain, to avoid missing a fracture. They argue that this approach would have prevented the delayed diagnosis in this case.

FAQs

  1. What is the surgical treatment for a scaphoid fracture?
  2. What can happen if a scaphoid fracture is left untreated?
  3. Why is it recommended to repeat the radiographic examination in suspected cases of scaphoid fractures?

Doctor’s Tip

One helpful tip a doctor might tell a patient about scaphoid fracture surgery is to follow post-operative instructions carefully, including keeping the surgical area clean and dry, wearing a splint or cast as directed, and attending follow-up appointments to monitor healing progress. It is important to avoid putting weight or strain on the affected wrist during the initial healing phase to prevent complications and promote proper bone healing. Physical therapy may also be recommended to regain strength and range of motion in the wrist after surgery.

Suitable For

Patients who are typically recommended scaphoid fracture surgery are those who have sustained a scaphoid fracture that is displaced, unstable, or at risk of non-union. This includes patients with bilateral scaphoid fractures, as in the case described in the abstract. Surgery may also be recommended for patients with delayed diagnosis of a scaphoid fracture, as early intervention can help prevent complications such as arthritis, deformity, and instability. Additionally, surgery may be considered for athletes and manual workers with stress fractures of the scaphoid to prevent further damage and disability. Comprehensive imaging should be done in all cases of suspected scaphoid fractures, even in the presence of modest symptoms, to avoid missed diagnosis and ensure appropriate treatment.

Timeline

  • Patient sustains bilateral, undisplaced scaphoid waist fractures during a football match
  • Initial clinical and radiographic evaluation only identifies left scaphoid fracture, which is treated with percutaneous Acutrack headless screw
  • Eight months later, patient returns to A&E with painful symptoms in right wrist, diagnosed with cystic scaphoid non-union
  • Osteosynthesis performed with Herbert headless screw and non-vascularized cortico-spongious bone grafts taken from radius
  • Periodic follow up with clinical examination, X-ray, and CT scan shows evidence of bone healing
  • Missed fracture on right wrist could have been avoided with repeated radiographic examination
  • Comprehensive imaging recommended for suspected scaphoid fractures after trauma, even with modest symptoms, to prevent missed diagnosis and potential complications such as arthritis, deformity, and instability.

What to Ask Your Doctor

Some questions a patient should ask their doctor about scaphoid fracture surgery include:

  1. What is the recommended surgical treatment for my scaphoid fracture?
  2. What are the potential risks and complications associated with scaphoid fracture surgery?
  3. How long is the recovery period after scaphoid fracture surgery?
  4. Will I need physical therapy or rehabilitation after the surgery?
  5. What type of anesthesia will be used during the surgery?
  6. How successful is scaphoid fracture surgery in terms of long-term outcomes?
  7. Will I need any additional imaging or tests before the surgery?
  8. How soon after the surgery can I return to my normal activities?
  9. Are there any lifestyle changes I should make to aid in the healing process?
  10. What should I do if I experience any pain or discomfort after the surgery?

Reference

Authors: Ghargozloo D, Tomarchio A, Ballerini M, Chitoni G. Journal: Med Glas (Zenica). 2021 Feb 1;18(1):222-225. doi: 10.17392/1332-21. PMID: 33480228