Scaphoid Non-Union Surgery

Nonunion scaphoid fracture after open reduction internal fixation left, referred for second opinion.

What is Scaphoid Non-union Surgery?

A scaphoid non-union fracture refers to a wrist fracture that is failing to heal. A fracture that is healing more slowly than expected is a “delayed union” fracture. Pain, weakness and stiffness ensue when broken bones do not heal in the customary time.

The scaphoid is one of the eight small carpal bones in your wrist joint and is on the thumb side.

To identify the scaphoid bone, hold your thumb in a “thumbs up” position. You’ll find it at the base of the hollow indent made by the thumb tendons. It is here in this area that patients will typically experience pain and tenderness after a scaphoid fracture.

Reconstructive surgery and immobilization generally help bones to heal. Internal fixation devices, e.g., pins and screws in conjunction with bone grafts – autogenous with or without vascularization – aid new bone formation and the union of fractures.

Bone stimulators are available to assist healing. An imperceptible magnetic field applied daily is one form of this modality.

Common Causes of a Scaphoid Non-Union

A Scaphoid Fracture can occur from a fall onto an outstretched hand during running, biking, skiing, snowboarding, skating, football, basketball, or while walking. Car accidents can result in a scaphoid fracture as well.

A fracture of the scaphoid is common and often frequent wrist injury but it is still overlooked or mistaken for a wrist sprain. The symptoms can be subtle because unlike other broken bone injuries, you may not notice swelling or intense pain around the scaphoid and the wrist.

Without that painful giveaway, a scaphoid fracture can remain undiagnosed for months or years which can lead to a non-union and other long-term consequences such as painful arthritis.

Diagnosis of a Scaphoid Non-Union

Despite today’s advanced diagnostic and treatment options, there is still a higher than usual chance for scaphoid fractures to progress to non-union. This is due to a limited blood supply to the bone. Initial x-rays may not reveal much because of the architecture of the fracture and the peculiar shape of the scaphoid.

Scaphoid fractures have a hard time healing on their own so it’s important to visit an experienced hand surgeon who uses specialized imaging to diagnose scaphoid fractures at early stage to optimize treatment.

Scaphoid non-union diagnosis steps include:

  • Imaging Scans: Medical imaging techniques may used such as an MRI to determine the level of blood supply around the fracture and a CT scan may be used to assess how the fractured bone is aligned and the degree of damage.
  • Non-Union Treatment: Depending on what is revealed from the physical examination and imaging scans, scaphoid non-union patients may need to undergo minimally invasive surgery to insert a screw to join and compress the broken bone fragments, with bone graft, sometimes vascularized.

When the scaphoid collapses you’ll notice a change in your wrist mechanics, a loss of motion, pain and arthritis.

About Scaphoid Non-Union Surgery

Scaphoid Fractures that just involve a break in the bone without movement of the fractured parts away from each other (Non-displaced) can be treated usually with cast immobilization when caught early. A scaphoid fracture that has been diagnosed late or has moved apart (Displaced) will benefit from arthroscopic surgery to realign the bone and insert a small screw to stabilize the fracture while it heals, as the risk of non-healing is significant in scaphoid fractures.

A scaphoid fracture at its proximal pole has a poor blood supply and may not heal with just a cast, so this kind of scaphoid fracture is a candidate for minimally invasive screw fixation.

A chronic scaphoid fracture that has not healed may be treated with surgery involving screw fixation and vascularized bone graft to generate healing.

In scaphoid non-unions because the bone has not healed on its own and immobilization alone won’t help, a new blood supply may need to be brought in to aid the healing process.

Vascularized bone grafts include bone donor sites near to or remote from the area for repair.

Avascular necrosis occurs when part of the scaphoid bone dies because of the loss of blood flow which can eventually lead to fragmentation and the collapse of the bone. Advanced reconstruction, including those mentioned above, are available to deal with this problem.

Conclusion

A Scaphoid Fracture requires prompt diagnosis and treatment to obtain adequate healing, as the bone’s weak blood supply can lead to non-healing and arthritis of the wrist joint. However, Scaphoid Non-Union Surgery can still help aid recovery after the fact. Call Dr. Pruzansky at 212-249-8700 to schedule an appointment if you have any concerns about a scaphoid fracture that has not healed properly.