Our Summary

This research paper investigates the differences between two types of fractures in the wrist bone known as the scaphoid: isolated scaphoid fractures (ISFs) and transscaphoid fracture-dislocations (TSFDs). The researchers studied the characteristics of these fractures in patients who came to their institution over a five-year period.

They found that ISFs are more common, making up 81% of the cases they examined. TSFDs, on the other hand, were less common but more severe. They often occurred closer to the top of the scaphoid bone and involved more fragmentation of the bone (a condition known as “comminution”).

Interestingly, while 12% of ISFs occurred in the lower third of the scaphoid bone, none of the TSFDs did. In addition, while 9% of ISFs showed comminution, 12% of TSFDs did.

The researchers concluded that TSFDs are likely to be the result of higher energy injuries, such as falls from a height or car accidents, due to their location and the higher degree of bone fragmentation. This information could be important for doctors treating these injuries, as it could help them decide on the best treatment approach.

FAQs

  1. What are the main differences between isolated scaphoid fractures and transscaphoid fracture-dislocations?
  2. What are the common causes of transscaphoid fracture-dislocations according to the research?
  3. How does the location and degree of bone fragmentation in scaphoid fractures potentially affect treatment approaches?

Doctor’s Tip

A helpful tip a doctor might tell a patient about scaphoid fracture surgery is to follow their post-operative care instructions carefully to ensure proper healing and prevent complications. This may include wearing a splint or cast, attending physical therapy, and avoiding activities that could put stress on the healing bone. It is also important to attend follow-up appointments with the doctor to monitor progress and make any necessary adjustments to the treatment plan.

Suitable For

Patients who have transscaphoid fracture-dislocations (TSFDs) are typically recommended scaphoid fracture surgery due to the severity of their injury. TSFDs are more likely to occur in high-energy injuries and involve more fragmentation of the bone, making them more complex and difficult to treat compared to isolated scaphoid fractures (ISFs).

In addition, patients with TSFDs may have a higher risk of complications, such as nonunion (failure of the bone to heal) or avascular necrosis (death of bone tissue due to lack of blood supply), which may require surgical intervention to achieve proper healing and prevent long-term issues.

Therefore, patients with TSFDs are often recommended surgery to stabilize the fracture, realign the bone fragments, and promote proper healing to restore function and reduce the risk of complications. Surgery may involve internal fixation with screws or pins, bone grafting, or other techniques depending on the specific characteristics of the fracture.

Timeline

Before scaphoid fracture surgery:

  1. Patient experiences a fall or traumatic injury to the wrist.
  2. Patient may experience pain, swelling, and difficulty moving the wrist.
  3. Patient seeks medical attention and undergoes imaging tests such as X-rays or MRI to diagnose the scaphoid fracture.
  4. Patient may be placed in a cast or splint to immobilize the wrist while waiting for surgery.

After scaphoid fracture surgery:

  1. Patient undergoes surgery to repair the scaphoid fracture, which may involve the placement of screws, pins, or plates to stabilize the bone.
  2. Patient will be monitored in the hospital for a period of time after surgery.
  3. Patient will be given pain medication and instructions on how to care for the surgical site.
  4. Patient may undergo physical therapy to regain strength and range of motion in the wrist.
  5. Patient will have follow-up appointments with their surgeon to monitor healing and remove any hardware used in the surgery if necessary.
  6. Patient may gradually return to normal activities, with full recovery taking several months.

What to Ask Your Doctor

  1. What type of scaphoid fracture do I have, and how severe is it?
  2. What are the potential risks and complications associated with scaphoid fracture surgery?
  3. What is the expected recovery time after surgery, and what can I do to help speed up my recovery?
  4. Will I need physical therapy or rehabilitation after surgery?
  5. What type of anesthesia will be used during the surgery?
  6. How long will I need to stay in the hospital after the surgery?
  7. What are the expected outcomes and prognosis for my scaphoid fracture?
  8. Are there any alternative treatment options to surgery that I should consider?
  9. How often will I need follow-up appointments after the surgery?
  10. Are there any specific restrictions or precautions I need to take during the recovery period?

Reference

Authors: Suszynski TM, Ben-Amotz O, Kargel JS, Bass R, Sammer DM. Journal: Hand (N Y). 2020 May;15(3):384-387. doi: 10.1177/1558944718795266. Epub 2018 Aug 24. PMID: 30139274