Located in the wrist, the scaphoid bone forms one of eight small bones.
What makes this particular bone the main topic of conversation, however, is that it is the most commonly fractured wrist bone.
Most fractures to the wrist occur when we take a tumble and fall onto outstretched hands. It is often instinctive when we fall to put our hands out to protect other parts of our body, but as a result, we damage the bones and bone tissue in our wrists.
Most fractures will heal without any further problems or complications; however, scaphoid fracture treatment can vary depending on whether the fracture is considered non-union.
In this post, we look at causes, symptoms, as well as treatment of scaphoid non-union and how we can help.
Scaphoid non-union definition
The scaphoid bone is a crucial part of our anatomy, as it is the bone that enables us to move our wrists into various positions.
Situated on the thumb side of the wrist and linking two rows of small bones within the wrist area, the scaphoid bone helps provide stability and coordination.
Most fractures tend to heal when placed in a cast and immobilised for approximately six to 12 weeks, depending on the fracture.
However, if the break is considered a displaced fracture, or for severe breaks where the blood supply has been completely cut off, or lubricating fluid enters the fracture, preventing normal healing to take place, there is a higher chance of the fracture not healing, and this is known as a non-union.
Due to the fragile blood supply to the scaphoid bone, when a fracture occurs, it may not always heal properly, as the nutrients necessary for healing are no longer available; hence, it becomes a scaphoid non-union.
This can lead to painful movement in the wrist, arthritis, and avascular necrosis in some cases (check out our post on everything to know about avascular necrosis to find out more).
Symptoms and causes of scaphoid non-union
Symptoms of scaphoid non-union
- Pain, especially when gripping objects, along the thumb side of the wrist.
- Limited/less movement available in the wrist.
- Uncomfortable feeling in the wrist.
- Swelling around the base of the thumb and the wrist.
- Problems carrying out everyday activities that involve the wrist.
You may show very few symptoms initially; however, if left untreated, these will progress, and we often see arthritis develop within the wrist, leading to scaphoid non-union advanced collapse, which causes significant pain and stiffness.
Causes of scaphoid fracture
- Sporting injuries involving the wrist.
- Falling with arms outstretched, with the wrist taking the impact of the fall.
- Excessive smoking can increase the chance of scaphoid non-union occurring as it reduces the flow of blood.
Diagnosis of scaphoid non-union
The best form of diagnosis is through an X-ray, which will show if a fracture is non-union.
If a more detailed analysis is required, you may be referred for a CT scan or MRI to show the blood flow in more depth.
Scaphoid fracture treatment
Plaster casts followed by hand therapy are often the most suitable form of treatment for straightforward fractures that aren’t deemed as displaced. If the fracture is displaced open surgery for fixation is required.
However, treatment for scaphoid non-union fractures will depend on whether arthritis is present in the wrist.
If there is no arthritis, scaphoid fracture surgery and bone grafting will be proposed as an option to realign the scaphoid bone and encourage the bone ends to heal. Carrying out this type of repair through surgery helps reduce the likelihood of arthritis developing in the future.
The surgery itself involves inserting a pin or screw into the middle of the scaphoid to hold the two-part bones together tightly. A bone graft will then be performed (typically taken from the pelvis or the wrist itself) to help refill the gap between the bone ends and promote union.
Surgery is carried out under general anaesthesia. After surgery, your arm will be elevated to reduce swelling, and you will need a splint or plaster to support the wrist until your healthcare professional is confident that the wrist has fully healed.
Rehabilitation and physiotherapy are undertaken after this to help regain full movement and flex of the wrist.
If arthritis is present in the wrist, surgery of this nature may not be the best option; instead, other treatments may be considered. Such as:
- Modifying daily activities
- Supportive splints
- Steroid injections.
There are surgical options available to help manage arthritis in the wrist, focusing on improving pain and maintaining wrist function and these would be discussed with you at your review appointment.
Scaphoid non-union
At Ladan Hajipour, our team is experienced in all types of fractures, understanding the symptoms that you are experiencing and knowing some of the causes that have led to a scaphoid non-union fracture, and we use our knowledge and experience to provide you with the best treatment solution for you.
Our friendly service helps put your mind at rest, knowing you’re in good hands.
Request an appointment today.