Sussex Hand CONDITION Surgery Scaphoid Fractures

CONDITION

The scaphoid is one of the small What is a bones that make up your wrist. It is the commonest wrist bone Scaphoid Fracture? to break.

Normal Wrist Xray Sometimes the diagnosis is delayed, Sometimes an operation is often by months or years. In this recommended. The exact situation xrays, MRI and CT scans approach will depend on the type might all be required to make a full of injury. Commonly a screw is Rest of the Thumb assessment of what is needed. placed down the centre of the metacarpal wrist bones scaphoid to keep the fragments (8 small bones lined up and still whilst the bone in total) The scaphoid What treatment is heals. This can sometimes be bone needed for a scaphoid done in a minimally invasive way fracture? with very small incisions (see Distal ulna This depends on a great many ‘Percutaneous screw fixation of Distal radius things. Some important factors are: Scaphoid Fractures’). Later on 1. How old is the injury? Fresh bigger operations might be A fracture of the scaphoid fractures have better healing necessary to re-align a bent potential scaphoid and put new bone into 2. Which part of the scaphoid is the old fracture (see ‘ORIF of broken? The nearer the fracture is Scaphoid Fractures +/-bone to end of the scaphoid next to the grafting’). radius (proximal pole) the more Very obvious chance there is of problems with What is the outcome fracture in the healing. This is to do with the blood following a scaphoid middle (waist) supply to the scaphoid bone which fracture? of the scaphoid is not good in the proximal pole. This mainly depends on whether 3. How badly out of position is the or not the scaphoid heals, how scaphoid in relation to the normal the shape of the scaphoid surrounding bones? The scaphoid How do scaphoid How is the diagnosis is after healing and how stiff the is rather ‘banana shaped’ normally. fractures occur? made? soft tissues get during treatment. If it breaks it tends to become The commonest way to break this This can be surprisingly difficult. It Associated injuries can also affect more bent in the middle. In that bone is simply to trip and fall is important to get a clear history the outcome. Even patients with case it does not line up with the landing heavily on the palm of your from you, the patient, and an apparently perfectly healed other bones in the wrist so well hand. The other way of breaking the examine the wrist very carefully. scaphoid fracture treated just in a and this can lead to arthritis in the scaphoid is by punching something. cast describe the occasional Often the fracture is obvious on a wrist later on (see page on ‘SLAC The fracture is common in young twinge in their wrist after this simple Xray. If no fracture is seen and SNAC wrist’). adults between 17 and 30 but can on the original Xray but significant bone has been broken. occur as early as 11 and as late as pain persists 10-14 days after the 4. Do you smoke? This increases into your 80s. injury a scan can be helpful to the chance of the scaphoid not confirm the diagnosis. A magnetic healing up. This probably relates to resonance imaging (MRI) scan is the blood supply to the bone most sensitive at picking up these which is reduced by smoking. injuries and this will also show up 5. What other structures are any other significant soft tissue damaged? These might also need injuries that might have occurred. treating.

www.sussexhandsurgery.co.uk These notes are intended as a guide and some of the © Sussex Hand Surgery details may vary depending on your individual January 2018 circumstance and at the discretion of your surgeon.