Scaphoid Fractures: Healing Progress and Treatment Questions

Could you please provide some specific questions regarding scaphoid fractures?

I had some questions during my follow-up appointment today that I forgot to ask the doctor, so I would like to inquire here.
I have a non-displaced scaphoid fracture that has been in a cast for six weeks.
The X-ray still shows the fracture line, but there seems to be something that looks like jelly growing at the ends of the fracture site on the screen.
What is that? Additionally, the doctor seemed to have mixed up the dates.
Initially, he mentioned that it might not heal, but later asked if it was a recent injury, to which I confirmed it had been exactly six weeks.
The doctor then said that the bone seems to be progressing.
I'm confused about what to believe.
I have an appointment scheduled in two weeks to remove the cast.
I would like to know if the fracture line is still visible in two weeks, can the cast really be removed? Thank you.

Xiao Hei, 30~39 year old female. Ask Date: 2016/04/08

Dr. Shi Guozheng reply Orthopedics

Scaphoid fractures of the wrist typically require a cast immobilization period of three months for healing, if they do heal.
These fractures often have a risk of nonunion, particularly when the fracture occurs in the middle portion of the bone, as the blood supply comes from the distal end.
This can lead to complications with healing.
If nonunion occurs, surgical intervention may be necessary.
Therefore, it is important to follow up with a physician to assess for these conditions before making further decisions.

Reply Date: 2016/04/08

More Info

Scaphoid fractures are a common type of wrist injury, particularly among young adults, often resulting from falls onto an outstretched hand. The scaphoid bone is located near the base of the thumb and is crucial for wrist mobility. When a scaphoid fracture is non-displaced and treated conservatively with a cast, as in your case, the healing process can be monitored through regular follow-up appointments and X-rays.

From your description, it seems that you have been in a cast for six weeks, and the X-ray shows the fracture line is still visible, with some new material appearing at the fracture site that looks like "jelly." This new material is likely callus formation, which is a part of the natural healing process. When a bone fractures, the body responds by sending cells to the area to begin repairing the bone. This process involves the formation of a soft callus, which eventually hardens into a bony callus as healing progresses. The presence of this callus is generally a positive sign, indicating that the body is attempting to heal the fracture.

Regarding your concerns about the healing progress and the doctor's comments, it is not uncommon for medical professionals to have varying opinions based on the healing trajectory of the fracture. The initial concern about non-union (the fracture not healing properly) is valid, especially with scaphoid fractures, as they have a higher risk of non-union due to their blood supply. However, if your doctor has indicated that there is progress after six weeks, it suggests that the healing process is on track.

As for the question of whether the cast can be removed if the fracture line is still visible in two weeks, this decision ultimately depends on the clinical judgment of your orthopedic surgeon. In many cases, if there is evidence of callus formation and the patient is not experiencing significant pain or instability in the wrist, the cast may be removed even if the fracture line is still present. However, if there are concerns about the stability of the fracture or if the healing is not progressing as expected, the doctor may recommend keeping the cast on for a longer period.

It is essential to communicate openly with your healthcare provider about your concerns. If you feel uncertain about the treatment plan or the healing process, do not hesitate to ask for clarification during your next appointment. You might also consider seeking a second opinion if you feel that your concerns are not being adequately addressed.

In terms of rehabilitation, once the cast is removed, physical therapy may be recommended to restore strength and range of motion to your wrist. It is crucial to follow your doctor's advice regarding when to start rehabilitation exercises, as premature movement can jeopardize the healing process.

In summary, scaphoid fractures can be tricky due to their unique anatomy and blood supply issues. The presence of callus formation is a good sign, and while the fracture line may still be visible, the decision to remove the cast will depend on your doctor's assessment of healing progress. Be proactive in your follow-up appointments, and ensure that you understand the next steps in your treatment plan.

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