Scaphoid Fracture Discussion

Scaphoid fractures are known to have unpredictable healing. This is due to the unique anatomy of the scaphoid itself. The fracture itself often cuts off normal blood circulation to pieces of the bone. Also, other wrist bones attached to each end of the scaphoid move broken pieces away from each other - so strongly that it may not be possible to hold them together with any type of cast. For this reason, these fractures may heal slowly (delayed union) or not at all (nonunion). Also, if circulation to part of the bone is cut off and not recovered, that part of the bone will deteriorate (avascular necrosis) and lead to degenerative arthritis. The scaphoid helps maintain the position of other wrist bones - which also can shift with a fracture. Xrays can be used to measure the wrist bone position (scapholunate angle). A particular pattern of wrist arthritis (SLAC wrist) may develop from these changes in the position of the other wrist bones. Conservative treatment involves prolonged immobilization for as many months as the fracture takes to heal. Because some fractures will fail to heal despite casting for a year or more, surgery may be needed to hold the bone pieces in place. Surgery to promote healing is most often recommended for displaced fractures and those which have failed to heal despite casting. This involves special hardware and possibly a bone graft. This type of surgery is not always technically possible. Degenerative arthritis is a definite possibility with these injuries and may require future reconstructive surgery. Exercise and therapy is recommended after the fracture heals. Other problems include weakness, persistent soreness, visible deformity, reflex sympathetic dystrophy and other possible problems. Stiffness after a scaphoid fracture is almost always seen.

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