Scaphoid fractures and non-union

The scaphoid one of the largest of the 8 carpal bones that make up the wrist joint. Fractures of the scaphoid occur quite commonly. They can be difficult to diagnose and unfortunately are sometimes missed. They most commonly occur from a fall on out-stretched hand, from simple falls or from sporting injuries.

Acute fractures

The treatment of these depends on the fracture pattern and whether it is displaced or un-displaced. “Hairline” fractures can be managed in a plaster cast, and most heal within 6 to 8 weeks, however, around 10-15% of scaphoid fractures do not heal and present with what is known as a non-union.

For this reason, I frequently offer surgical fixation of a scaphoid fracture, as with early surgery non-union is unlikely. The other benefit of early surgery is that the return to work, driving and sport is generally quicker.

Non-union of the Scaphoid

Occasionally a patient will present with a scaphoid non-union, often many months or years after a wrist injury. This is a more challenging problem to deal with and surgery is usually advised, as they are often associated with pain and loss of wrist function.

The surgery depends on the severity and position of the non-union within the scaphoid, and whether there is any arthritis associated with the non-union. Over time a scaphoid non-union changes the way the wrist bones move in relation to one another, and this leads to a progressive, predictable pattern of arthritis. This is known as Scaphoid Non-union Advanced Collapse, or SNAC wrist.

Patients without arthritic change usually require internal fixation of the scaphoid with a bone graft. This can be taken from the hip (iliac crest, the prominent wing of the pelvis) or from the wrist itself, often taken with a small blood vessel (vascularised bone graft).

Patients presenting with arthritis usually require removal of the scaphoid, with partial wrist fusion or excision of the bones in the first row of the carpus (wrist), know as a proximal row carpectomy.

What is the likely recovery?

This depends on the nature of the surgery. Non-union surgery is major, and the recovery period can be quite long, often in excess of 3 months.