Scaphoid Fracture

Symptoms: Common signs and symptoms of a scaphoid fracture may include:

• Pain and tenderness in the wrist, particularly on the thumb side.
• Swelling and bruising around the wrist joint.
• Difficulty or pain with gripping or squeezing objects.
• Limited range of motion in the wrist, particularly with bending or twisting movements.

Location: The scaphoid bone is located in the proximal row of carpal bones, near the base of the thumb. It has a unique shape, resembling a boat or a peanut, and links the two rows of carpal bones.

Causes: Scaphoid fractures commonly occur due to falls onto an outstretched hand, especially when the hand is extended to break the fall. The impact force is transmitted through the wrist joint, causing the scaphoid bone to absorb the stress and potentially fracture.

Diagnosis: Scaphoid fractures can be challenging to diagnose, as they may not always be visible on initial X-rays, especially in the early stages of injury. However, if a scaphoid fracture is suspected based on clinical evaluation and symptoms, additional imaging studies such as MRI, CT scan, or specialized X-ray views (e.g., scaphoid views) may be necessary to confirm the diagnosis.

Treatment: The treatment approach for a scaphoid fracture depends on factors such as the location, displacement, and stability of the fracture, as well as the patient’s age, activity level, and overall health. Treatment options may include:

Immobilization: For nondisplaced or minimally displaced fractures, immobilization in a cast or splint may be sufficient to allow the fracture to heal.

Surgery: In cases of displaced or unstable fractures, surgery may be necessary to realign the bone fragments and stabilize the fracture with screws, pins, wires, or other implants.

Rehabilitation: Following treatment, rehabilitation and physical therapy may be recommended to restore range of motion, strength, and function to the wrist joint.

Scaphoid fracture surgery is typically recommended for displaced or unstable fractures of the scaphoid bone, as well as for fractures that fail to heal with non-surgical treatment.

The goal of surgery is to realign the fractured bone fragments, stabilize the fracture, and promote proper healing to restore function and prevent long-term complications.

Open Reduction and Internal Fixation (ORIF): ORIF is the most common surgical procedure for treating displaced or unstable scaphoid fractures.

During ORIF, Dr. Pournaras will make an incision over the wrist and expose the fractured scaphoid bone. The fractured bone fragments are then carefully realigned (reduced) into their proper position using surgical instruments and techniques.

Once the bones are aligned, they are stabilized using specialized implants such as screws, pins, wires, or plates to hold the fracture fragments together while they heal.

The implants may be placed through the same incision or additional small incisions, depending on the fracture’s complexity. ORIF may be performed under general anesthesia or regional anesthesia (nerve block), depending on the patient’s preference.

Percutaneous Screw Fixation: Percutaneous screw fixation is a minimally invasive surgical technique used to stabilize certain types of scaphoid fractures. During this procedure, Dr. Pournaras will make a small incision over the wrist or uses fluoroscopic guidance to insert a screw directly into the fractured scaphoid bone to stabilize the fracture. Percutaneous screw fixation may be performed under local anesthesia with sedation, and it typically results in smaller incisions and faster recovery compared to traditional open surgery.

Bone Grafting: In cases of significant bone loss or delayed healing of the scaphoid fracture, bone grafting may be necessary to promote bone union and stability. Bone grafts may be harvested from the patient’s body (autograft) or obtained from a donor (allograft) and placed at the fracture site to support bone healing and restore structural integrity.

Arthroscopic-Assisted Reduction and Fixation: Arthroscopic techniques may sometimes be combined with traditional ORIF to assist with fracture reduction and visualization of the joint surface. Arthroscopic-assisted reduction and fixation allow for minimally invasive surgery and may help improve outcomes by facilitating more accurate reduction and restoration of joint congruity.

After surgery for a scaphoid fracture, patients typically undergo a period of immobilization in a splint or cast to protect the surgical repair and allow for initial healing. Physical therapy and rehabilitation exercises are then initiated to restore range of motion, strength, and function to the wrist joint. The specific rehabilitation protocol will depend on the type of surgery performed, the severity of the fracture, and the individual patient’s needs and goals.

Surgery for a scaphoid fracture aims to achieve proper alignment, stability, and function of the wrist joint, allowing patients to regain mobility and return to normal activities with minimal long-term effects. 

Recovery after scaphoid fracture surgery can vary depending on factors such as the type of surgery performed, the severity of the fracture, and individual patient factors. 

Immediate Postoperative Period: After surgery, patients are typically monitored in the recovery room until they are awake and stable. Pain management is a priority during this time, and patients may receive pain medications as needed to keep them comfortable. The surgical incision site is dressed, and the affected arm is typically placed in a splint or cast to immobilize the wrist and protect the surgical repair.

Immobilization: Immobilization of the wrist is essential for allowing the bones to heal properly after surgery. Depending on the type of surgery performed and the stability of the fracture, patients may be placed in a cast, splint, or removable brace for several weeks to months.

Physical Therapy and Rehabilitation: Once the initial immobilization period is complete, patients begin a structured rehabilitation program to restore range of motion, strength, and function to the wrist joint. Physical therapy exercises may include gentle stretching, passive and active range of motion exercises, and strengthening exercises for the muscles surrounding the wrist and forearm. Patients may also undergo manual therapy techniques, such as joint mobilizations and soft tissue massage, to improve mobility and reduce stiffness in the wrist. Rehabilitation typically starts with supervised therapy sessions and may progress to a home exercise program as the patient’s strength and function improve.

Gradual Return to Activities: As the wrist continues to heal and rehabilitation progresses, patients gradually increase their activity level and return to normal daily activities. Depending on the type of surgery performed and the patient’s progress, activities such as driving, lifting, and sports participation may be gradually reintroduced over several weeks to months.

X-rays may be taken periodically to evaluate the alignment and healing of the fracture and ensure that the surgical repair remains stable.

Patients may continue with maintenance exercises and lifestyle modifications to support long-term joint health and prevent future injuries.