The patients who I see with scaphoid non-unions either have had their fracture correctly treated at the time but it still has not healed or they did not have their fracture diagnosed at the time and in some cases cannot even remember injuring their wrist in the past. If a scaphoid fracture does not heal and develops into a non-union then this can cause continuing pain and stiffness of the wrist and in the longer term, it can lead on to osteoarthritis. What happens if the fracture doesn’t heal? This stabilises and compresses the fracture, encouraging it to unite. This involves inserting a metal screw into the bone, which can be done with keyhole surgery as a day-case, usually with an arm block with the patient awake the fracture is lined up guided by an X-ray machine and through an approximately 5mm incision the screw is inserted into the bone. If the fracture is at the bottom end of the bone (proximal pole), the blood supply is less good and there is a higher risk of the fracture not healing in a cast, if there is displacement of a scaphoid fracture, or if it is not healing in the expected time in a cast, then it can be treated surgically. About 90% of fractures will heal with this treatment. Some patients think they have just sprained their wrist and don’t attend hospital or they do, but the X-ray looks normal and the fracture is not diagnosed, and they don’t, therefore, get treated.įor most scaphoid fractures, there is very little displacement between the two parts and the fracture is treated by immobilising the wrist in a plaster cast.
The likelihood of a scaphoid fracture not healing is increased if the wrist has not been immobilised in a cast, if the fracture is of the proximal pole of the scaphoid, if the fracture is displaced, or if the patient is a smoker. The bone has a poor blood supply, which makes it more difficult for fractures to heal.Ībout one in ten scaphoid fractures do not heal when treated in a cast. The scaphoid is a notorious bone for causing long-term problems and because of its shape, it can be difficult to diagnose fractures. In which case a CT or MRI scan will show it. Scaphoid fractures can usually be diagnosed with an X-ray, but sometimes there is a fracture which isn’t visible on a plain X-ray. Patients complain of pain in the wrist, there may be slight swelling, pain trying to move the wrist, and pressing on the side of the wrist is tender. What are the symptoms and how is it diagnosed? Here, one of our expert orthopaedic surgeons Mr James Nicholl explains more, from symptoms to how the condition is treated if it does not heal. Scaphoid fractures can be caused by falling onto the hand, or by anything which forces the wrist backwards, or by punching injuries.
This is a small bone which lies between the thumb and the side of the wrist. The most common one to be fractured is called the scaphoid. There are eight carpal bones in the hand.
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