Our Summary

This study looked at patients who had hidden wrist bone (scaphoid) fractures that were only discovered after having an MRI scan. They wanted to see how often these fractures didn’t heal properly or at all.

The study was conducted across eight UK centers, and looked at patients who had a wrist injury but normal X-rays, and then had an MRI which showed a scaphoid fracture. They followed these patients for at least a year.

Out of 1,989 patients who had an MRI due to a suspected wrist bone fracture, 256 (about 13%) were found to have a hidden scaphoid fracture. Out of these, 6 had surgery right away, and 16 (about 6%) didn’t heal properly or at all even after having their wrist put in a cast. Nine fractures didn’t heal at all, seven of which had surgery, one chose not to have surgery, and one didn’t come back for follow-up. Of the seven fractures that didn’t heal properly, one had surgery at two months, one didn’t come back for follow-up, and five healed after having their wrist put back in a cast. All the fractures that were treated with surgery healed. There was one complication from surgery where a screw had to be removed.

The findings show that hidden wrist bone fractures aren’t always harmless. Over 6% didn’t heal properly or at all even with a cast, and most needed surgery to heal. This supports the idea of using an MRI early on for these patients.

FAQs

  1. What percentage of patients with suspected wrist bone fractures were found to have hidden scaphoid fractures?
  2. How effective was the use of a cast in healing scaphoid fractures in the study?
  3. What treatment options were shown to be most effective for hidden scaphoid fractures in this study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about scaphoid fracture surgery is to follow post-operative instructions carefully, including keeping the wrist immobilized as directed, attending all follow-up appointments, and participating in any recommended physical therapy to aid in the healing process. It is important to communicate any concerns or changes in symptoms to your healthcare provider promptly to ensure proper healing and recovery.

Suitable For

Patients who have a hidden scaphoid fracture that is only discovered with an MRI scan are typically recommended surgery if the fracture does not heal properly or at all with conservative treatment such as casting. Additionally, patients who have complications with their fracture, such as displacement or non-union, may also be recommended surgery. Patients who have a high demand for wrist function, such as athletes or manual laborers, may also be recommended surgery to ensure optimal healing and function of the wrist.

Timeline

Before scaphoid fracture surgery:

  • Patient experiences a wrist injury and undergoes X-rays, which may not show a fracture.
  • Patient undergoes an MRI scan, which reveals a hidden scaphoid fracture.
  • Patient may undergo conservative treatment such as casting, but the fracture may not heal properly.

After scaphoid fracture surgery:

  • Patient undergoes surgery to fix the scaphoid fracture.
  • Fracture heals successfully after surgery, with all cases in the study showing successful healing.
  • Some patients may experience complications from surgery, such as the need to remove a screw.
  • Patients are followed up for at least a year post-surgery to monitor healing and any potential complications.

What to Ask Your Doctor

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

  1. What are the risks and potential complications associated with scaphoid fracture surgery?
  2. What is the success rate of scaphoid fracture surgery in terms of healing properly?
  3. How long is the recovery process after scaphoid fracture surgery?
  4. Will physical therapy be necessary after scaphoid fracture surgery?
  5. What type of anesthesia will be used during the surgery?
  6. How soon after the surgery can I return to normal activities?
  7. Will I need to have any follow-up appointments or imaging studies after the surgery?
  8. Are there any restrictions or precautions I should take after scaphoid fracture surgery?
  9. What are the alternative treatment options to surgery for a scaphoid fracture?
  10. How experienced is the surgeon in performing scaphoid fracture surgeries?

Reference

Authors: Dean BJF, Riley N, Little C, Sheehan W, Gidwani S, Brewster M, Dhiman P, Costa ML. Journal: Bone Joint J. 2024 Apr 1;106-B(4):387-393. doi: 10.1302/0301-620X.106B4.BJJ-2023-1171.R1. PMID: 38555933