What is it?
The scaphoid is the bone of the wrist, which performs a fundamental function in the wrist joint. It is endowed with a very complex mobility that occurs in several planes, which contributes to the best movement conditions of the wrist in relation to the forearm. It has a very complex shape that allows it to articulate with several adjacent bones; 80% of its surface is covered by articular cartilage.
For these reasons, its integrity is essential for the proper functioning of the wrist.
The scaphoid bone is also rather exposed and vulnerable to trauma, as is often the case in a fall, when the natural defensive position forces us to secure ourselves by first placing our hands on the ground.
The special vascular conditions of the scaphoid bone (it receives nourishment from a single artery), make its recovery processes quite difficult, so much so that a fracture of this bone takes longer to heal than other bones, and if not properly treated often fails to heal. This results in what is known as "pseudoarthrosis".
A non-healed fracture of the scaphoid bone is quite well tolerated, the pain subsides over time and motor function is restored with minimal restrictions.
However, in the long term, the presence of a non-healed fracture determines the mechanical instability of the wrist, which gradually leads to premature wear of the wrist joints and the occurrence of arthrosis, even severe and extremely disabling, which often requires surgery for treatment, which can lead to a significant reduction in mobility and function of the wrist.
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.
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