Which are the symptoms?
- Decreased mobility of the wrist
How is it diagnosed?
In wrist injuries with suspected fractures of the scaphoid bone, a wrist X-ray should be performed in standard projections + oblique projection specific to the scaphoid bone.
This examination is sufficient to detect fractures, but complex fractures (i.e. without removal of bone fragments) can only be detected several days after injury.
In these cases, a CT scan should be performed, which also reveals irreparably healed fractures.
If a CT scan is not possible, it is good practice to immobilise the wrist for 7-10 days and take a new X-ray at the end of this period, after which even misidentified fractures become visible.
How is it treated?
There are many treatment options for fractures of the scaphoid bone.
Simple and complex fractures can be treated by immobilisation in a plaster cast. Immobilisation must be longer than for other fractures, as the scaphoid bone is difficult to consolidate and sometimes reparative effects do not occur in spite of proper immobilisation.
Today surgery offers minimally invasive treatment options that increase the chances of healing of the scaphoid bone and significantly reduce the time of immobilization, which in some cases is not necessary at all. The surgery involves inserting a screw through a small skin incision, takes a few minutes under peripheral anaesthesia and does not require hospitalisation.
More complex is the surgical treatment of pseudo-arthrosis, i.e. unhealed fractures.
In these cases, in addition to stabilisation with a screw or other fusion means, it is necessary to remove the part of the scaphoid bone affected by the unhealed fracture and replace it with a bone graft. Depending on the case, this can either be a simple bone fragment taken from the pelvis or other anatomical sites, or a more complex vascularised bone graft, which, with a more complex technique requiring microsurgical skills, allows blood supply to the scaphoid bone, improving its biological condition.
The choice of the type of technique used depends on the specific conditions and must be decided individually for each patient, but it is important that the surgeon is familiar with all these techniques, so it is advisable to entrust these cases to an experienced hand surgeon.
The procedure is usually performed on an outpatient basis and does not require hospitalisation.
A post-operative rehabilitation program under the supervision of a hand therapist is necessary.