Scaphoid fracture non union

What is the scaphoid?

There are 8 small bones at the bottom of your hand called the carpal bones. One of these bones is called the scaphoid.

The scaphoid is located at the base of your thumb.

This bone can easily be broken (fractured) due to a fall on the outstretched hand.

How does non-union occur?

Bones require a good blood supply to ensure healing following a fracture. If the blood supply is damaged delayed healing (delayed union) or no healing (non-union) may occur. The scaphoid bone has a very fragile blood supply and so fractures of this bone carry a high risk of not healing. Smoking damages very small blood vessels and this can be a significant risk factor for non-union occurring.

How do I know if my scaphoid has not healed?

Pain persists long after your cast has been removed, beyond the normal recovery period.  The pain may be very minimal and may gradually increase in intensity. The pain normally arises when using the wrist. Special scans (CT or MRI) may be required to fully diagnose non-union.

If the scaphoid bone does not heal fully, there is a significant risk of wrist arthritis developing. Stiffness in the wrist may remain even if the fracture subsequently heals.

Surgery

Once the diagnosis has been confirmed surgery may be indicated. Surgery may reduce the risk of arthritis developing, however even with successful surgery the risk of arthritis can remain due to the original injury.

Surgery is performed through a small wound at the front or back of the wrist. The fracture site is cleaned and the scaphoid fixed with a small screw. Usually a small piece of bone (bone graft) is taken from just above the hip (near the belt line) and is place in the fracture gap. This encourages healing and restores the original shape of the scaphoid bone.

Following surgery a plaster cast is applied and is worn for 2 to 6 weeks. Healing of the fracture is then monitored by x-rays taken at regular outpatient visits.