Scaphoid fracture or nonunion

Scaphoid fracture or nonunion: this condition involves a fracture to one of the main bones in the wrist. Trauma to an extended wrist from a fall, car accident, or sports injury is the typical presentation.

Signs/symptoms include swelling of the wrist, limited wrist motion and function, pain with range of motion of the wrist, and pain over the hollow on the inside of the wrist.

Treatment

Treatment initially is immobilization of the wrist to include the thumb. This is extremely important because of the limited healing potential of this fracture. Often times, fracture healing can take up to 3 to 6 months in a cast. Injuries that are not treated initially commonly can lead to a nonunion or failure of healing of the fracture. This can lead to chronic wrist pain and a predictable pattern of arthritis, or even to bone death (avascular necrosis).

Surgery

Surgical intervention is reserved for acute injuries when there are associated fractures that need to be treated surgically or with fractures that have a high likelihood of failure to heal in a cast. For fractures that have not healed with cast treatment, bone graft with or without screw fixation to the area of nonunion is helpful to stimulate the healing process. With a nonunion involving dead bone (avascular necrosis), a process to stimulate blood flow to the area (vascularized bone graft) is necessary.