Our Summary

This research paper discusses various surgical options for treating a condition called scaphoid nonunions, which is when a broken bone in the wrist (specifically, the scaphoid bone) doesn’t heal properly. The complexity of the treatment increases the longer the time from when the injury occurred.

For scaphoid nonunions that are less than a year old and don’t show any misalignment of the wrist bones, a minimally invasive procedure can be used. This involves inserting a screw to stabilize the bone, guided by imaging technology.

In cases where patients need to have the procedure redone, or where the upper part of the scaphoid bone has lost its blood supply but doesn’t need a large graft, a specific type of bone graft using blood vessels is a reliable treatment.

If the scaphoid nonunion is old or previous treatments have failed, removing the lower part of the scaphoid bone can be a good option.

Lastly, when the joint between the scaphoid and the radius bone (one of the main bones in the forearm) shows signs of degenerative changes, more complex procedures like removing a row of wrist bones may be considered.

FAQs

  1. What surgical strategies are used for scaphoid nonunions less than 1 year after trauma?
  2. When should proximal row carpectomy be considered for scaphoid fractures?
  3. How are patients with avascular proximal poles treated during scaphoid fracture surgery?

Doctor’s Tip

A doctor may advise a patient undergoing scaphoid fracture surgery to follow post-operative care instructions carefully, including immobilizing the wrist as directed, attending physical therapy appointments, and avoiding activities that may put stress on the healing bone. It is important to communicate any changes in symptoms or concerns with the doctor to ensure proper healing and recovery.

Suitable For

Patients who are typically recommended scaphoid fracture surgery include those with scaphoid nonunions less than 1 year after trauma and no carpal malalignment, reinterventions or patients with avascular proximal poles that do not need substantial grafts, old nonunions or after a failed scaphoid procedures, and those with radioscaphoid degenerative changes. In these cases, surgical strategies such as percutaneous screw fixation, pedicle vascularized bone grafts, resection of the distal pole of the scaphoid, and salvage procedures like proximal row carpectomy may be recommended.

Timeline

Before scaphoid fracture surgery:

  1. Patient experiences trauma or injury to the wrist.
  2. Patient may experience pain, swelling, and limited range of motion in the wrist.
  3. Patient undergoes X-rays or other imaging tests to diagnose the scaphoid fracture.
  4. Patient may be placed in a cast or splint to immobilize the wrist and promote healing.

After scaphoid fracture surgery:

  1. Patient undergoes surgical intervention, such as percutaneous screw fixation or vascularized bone grafting, based on the severity of the fracture and time since injury.
  2. Patient may require a period of immobilization in a cast or splint following surgery.
  3. Patient undergoes physical therapy to regain strength and range of motion in the wrist.
  4. Patient follows up with healthcare provider for monitoring of healing and to ensure proper rehabilitation.
  5. Patient may need to avoid certain activities or modify daily tasks to prevent re-injury to the wrist.

What to Ask Your Doctor

  1. What are the risks and potential complications associated with scaphoid fracture surgery?
  2. What is the expected recovery time after surgery?
  3. Will I need physical therapy or rehabilitation after surgery?
  4. How long will I need to wear a cast or splint after surgery?
  5. What type of anesthesia will be used during the surgery?
  6. Will I need to stay in the hospital overnight after the surgery?
  7. What type of follow-up care will be needed after surgery?
  8. What are the chances of the fracture healing successfully after surgery?
  9. Are there any alternative treatment options to surgery for a scaphoid fracture?
  10. How experienced are you in performing scaphoid fracture surgeries?

Reference

Authors: Borges CS, Ruschel PH, Pignataro MB. Journal: Orthop Clin North Am. 2020 Jan;51(1):65-76. doi: 10.1016/j.ocl.2019.08.010. Epub 2019 Oct 17. PMID: 31739880