Scaphoid Fractures of the Wrist: Treatment Options

Scaphoid Fractures of the Wrist: Treatment Options

This video will provide an overview of treatment options for scaphoid fractures, both with and without surgery. Breaks in the scaphoid are the most common fractures seen in the carpal bones. The unique anatomy of the scaphoid, particularly its poor blood supply, makes proper treatment critical to preventing long-term healing complications. If a scaphoid fracture is stable, meaning the pieces of broken bone have not moved position, then treatment may be considered without surgery. If a scaphoid fracture is suspected based on symptoms and exam, but normal x-rays are seen, treatment without surgery will be advised initially. Given scaphoid fractures can be missed on initial x-rays, repeat imaging may be advised in a few days with x-rays or an MRI.

A cast will be recommended so the fracture does not move during healing. Usually, this is for a minimum of 6 weeks, followed by additional x-rays to check for healing. Various cast types may be used, and studies have indicated no difference in healing based on the differences shown. The health care provider will recommend the best cast for each individual. Hand therapy will be advised when the cast is removed to help regain strength and function. Given improvements in minimally invasive surgical options, surgery may be considered even for stable fractures. Early treatment with surgery may improve function sooner than no surgery. This is considered in athletes or laborers who must return quickly to their sport or job.

There are several indications for surgery for these fractures. The most common is if a fracture is unstable, meaning the pieces of bone have moved significantly. Another common reason for surgery includes fractures in a specific portion of the bone, called the proximal pole. This part of the bone has poor blood supply and may need encouragement to heal with surgery. If a scaphoid fracture has not healed after several months, this is called a nonunion fracture, and surgery may be needed. Speaker1: These fractures can be treated in a variety of ways, 1 of which is a minimally invasive option. This uses a small skin incision and a guidewire to place a screw across the broken bone. Other options may require a larger incision to view the fracture site during the surgery.

This incision may be to the top or bottom of the wrist. In either approach, an implant will hold the fractured bone together while it heals. This is typically with a compressive screw. These screws are unique and have no screw head. This design sits just below the surface of the bone, so it does not rub on nearby structures, which is important in bones with many joint surfaces, like the scaphoid. They are hollow-bodied screws that can be inserted over a wire with a very small incision. Lastly, they have threads that are placed at differing distances and have different widths at the top and bottom, which help provide optimal compression of the fracture. Occasionally, a surgeon will use a small camera to view the broken bone and nearby anatomy during the procedure.

After surgery, a patient will be placed in a cast or splint for several weeks during healing. There is no agreed-upon time frame for how long this will take. It depends on each patient's fracture, health, and demands. The health care team will advance rehabilitation to regain strength and function once the fracture shows enough healing. These fractures are generally treated without surgery when stable. However, surgery may yield a quicker recovery in certain populations. Surgery is required for unstable fractures and those in certain parts of the bone due to known poor blood supply. Generally, compressive screw implants are used in surgery. Finally, a cast or splint may be used for treatment with or without surgery.