The scaphoid bone, a small peanut-shaped carpal bone of the wrist, is the most common carpal bone that is broken from injury. The blood supply to the scaphoid is greatly affected when fracture to the bone occurs. Loss of adequate blood flow to the bone consequently slows down the healing process. Because of the poorer blood supply, scaphoid fractures must be treated in a cast or with surgery to allow for healing of the bone. If left untreated, the broken scaphoid is unable to heal and will progress to a non-union (meaning no union or healing occurs between the fractured ends of the bone). Scaphoid fractures are typically difficult to identify early and are easily missed as wrist sprains initially. Unfortunately, missed scaphoid fractures will later present as a non-union. Over months and years of no treatment, non-union of the scaphoid leads to further deformity of the bone, possible dead bone (also known as avascular necrosis), and arthritis of the wrist which results in loss of wrist motion, loss of grip strength, swelling, and chronic wrist pain.
Timing from initial injury and pattern of the scaphoid fracture can have significant impact on the possible treatment options for scaphoid fracture non-union. This condition is a very difficult problem to treat successfully. The earlier the scaphoid non-union is identified, chances for successful treatment are certainly better. If the scaphoid bone does not develop a “humpback” deformity, maintains some blood supply, and is fractured through its “waist”, treatment may be successful with placement of a headless compression screw along with the possible need to add bone graft (additional bone added to provide structure to the non-healed bone along with growth factors that stimulate bone healing). However, if the scaphoid has no blood supply or dead bone, then complex surgery for a vascularized bone graft (transferring bone with a blood supply attached) may be necessary in addition to fixing the scaphoid with a screw.
If the pattern of scaphoid non-union advanced collapse of the wrist develops, arthritis of the wrist in various stages occurs, and fixing the bone is no longer possible. Typically some form of surgery for carpal bone removal and partial fusions of the wrist may be necessary depending on the degree of symptoms and x-ray findings. For the most advanced stages of symptomatic arthritis, a complete surgical fusion of the wrist may be necessary. These surgical options each have limited success and may only be suitable for select patients. Dr. Mark A. Katz is a specialist with expertise in the treatment of wrist fractures. Dr. Katz will discuss these various options to help you choose the treatment that is best for you.