SCAPHOID FRACTURE AND NON-UNION
Scaphoid fracture and non-union – a risk for the wrist
The scaphoid (os scaphoideum) is one of the carpal bones. It sits on the thumb side of the wrist. As an intermediate element it transfers force from the fingers and the middle of the hand to the forearm. Because of its shape and position it is heavily loaded mechanically when force is applied – in a fall onto the outstretched wrist, for example – and is prone to fracture. Younger people are frequently affected, after a fall while playing football, snowboarding or mountain biking. If a scaphoid fracture does not heal in a fully stable position, this very probably leads to a non-union (the fracture fails to heal and a false joint forms). In a non-union the scaphoid is mobile, and the altered mechanics that go with this lead to increased wear of the cartilage in the wrist.
Symptoms
A fracture of the scaphoid frequently causes only slight or non-specific symptoms, which is why it is easily overlooked.
Dull pain
Pressure on the thumb side of the wrist can produce a (mild) pain.
Bruising at the wrist
The fracture can cause bruising on the thumb side of the wrist.
Pain under load
A fracture that has not healed causes symptoms under load that get worse over time.
Recognising a scaphoid injury correctly – early and reliably
As soon as a fresh fracture of the scaphoid or a non-union is suspected, an X-ray with a special view of the wrist is needed. If no fracture can be seen but the symptoms still suggest one, a CT or a cone beam CT should be carried out. The cone beam CT has the same diagnostic value at a considerably lower radiation dose. If the X-rays show a non-union of the scaphoid, an MRI scan is needed in addition, as this shows the blood supply to the bone. The surgical approach can then be adjusted accordingly
Treatment options for a scaphoid fracture
Treatment depends on the site and extent of the fracture and on how healing progresses
Treatment options
Non-surgical and surgical – we will find the right approach for you
Consistent immobilisation of a fresh fracture
A stable synthetic cast including the wrist and the thumb has to be worn for at least 6 to 12 weeks.
Fixing the fracture with a screw
A screw stabilises the scaphoid and compresses the fracture gap.
Clearing the non-union and filling it with bone
With a non-union, the tissue that has failed to heal is removed and the defect filled if necessary with the patient's own bone (cancellous bone), usually taken from the iliac crest.
Our hand specialists
Experienced consultants for scaphoid fractures and hand surgery
