Scaphoid Fractures: Treatment Options and Risks

Q: Scaphoid Fractures: Treatment Options and Risks

Hello： The arthritis resulting from a non-union of the scaphoid fracture may not manifest quickly, so your current symptoms may not be pronounced. <br>However, considering your age, I personally recommend addressing any existing avascular necrosis. <br>I believe that bone graftin

Scaphoid fracture

Doctor, I had a scaphoid fracture from a car accident four years ago that I didn't pay attention to.
Recently, the lower part of the fracture has started to turn white and necrotic, but when the doctor presses around the scaphoid area of my hand, I don't feel any pain.
The rehabilitation therapist said that since there is no pain, surgery is not necessary.
However, the hand surgeon recommends surgery with autologous bone grafting to see if the bones can fuse together.

If I choose not to have surgery, what will happen in the future? If I do have surgery, can it be done using microsurgery, or is autologous bone grafting the only option? What are the chances of healing after the surgery? The attending physician mentioned that since the lower part has already turned white and necrotic, we should proceed directly with the bone grafting surgery, but this might significantly limit the range of motion in my wrist later on.
Thank you for your response, doctor.

Cheng, 30~39 year old female. Ask Date: 2019/06/10

Dr. You Dianqi reply Orthopedics

Hello: The arthritis resulting from a non-union of the scaphoid fracture may not manifest quickly, so your current symptoms may not be pronounced.
However, considering your age, I personally recommend addressing any existing avascular necrosis.
I believe that bone grafting (autologous bone) will likely be necessary.
Your concern seems to pertain to whether a vascularized autologous bone graft (typically requiring microsurgery) or a non-vascularized autologous bone graft (generally not requiring microsurgery) is needed.
Each option has some supporting literature.
I suggest discussing this further with your attending physician.
Wishing you a speedy recovery.

Reply Date: 2019/06/10

More Info

Scaphoid fractures are a common type of wrist injury, particularly following trauma such as a car accident. The scaphoid bone, located in the wrist, is critical for wrist stability and function. When a scaphoid fracture occurs, especially if it goes untreated, it can lead to complications such as nonunion (where the bone does not heal properly) or avascular necrosis (where the bone tissue dies due to lack of blood supply).
In your case, it seems that you have experienced a scaphoid fracture that has not healed properly over the past four years. The fact that the area has started to show signs of necrosis (indicated by the "whitening" you mentioned) is concerning. This could suggest that the blood supply to the bone has been compromised, which is a serious issue.
Your rehabilitation therapist's observation that you do not feel pain in the area is somewhat reassuring, but it does not negate the potential risks associated with a nonunion or necrotic bone. If the scaphoid does not heal, you may experience long-term complications, including chronic pain, decreased wrist function, and the potential for arthritis in the wrist joint.
Regarding your treatment options, surgical intervention is often recommended for scaphoid fractures that do not heal on their own. The procedure your doctor suggested, which involves using a bone graft (autologous bone graft) to promote healing, is a common approach. This method involves taking a small piece of bone from another part of your body and placing it in the scaphoid to encourage healing.
You asked about the possibility of using microsurgery. While microsurgical techniques can be employed in various orthopedic procedures, the specific approach to your scaphoid fracture will depend on the extent of the damage and the surgeon's expertise. If the necrotic area is significant, your surgeon may recommend a straightforward bone graft without the need for advanced microsurgical techniques.
The healing rate after surgery can vary based on several factors, including the extent of the injury, the quality of the bone graft, and your overall health. Generally, the success rate for scaphoid bone grafting is quite high, especially when performed by an experienced orthopedic surgeon. However, there is always a risk of complications, including infection, nonunion of the graft, or limitations in wrist motion post-surgery.

If you choose not to undergo surgery, you may face the risk of persistent pain and dysfunction in your wrist. Over time, the necrotic bone may lead to further complications, including the development of arthritis, which could severely limit your wrist's range of motion and functionality.

In conclusion, while surgery carries its own risks, it may be the best option to prevent further complications and restore function to your wrist. It is crucial to have a thorough discussion with your orthopedic surgeon about the potential outcomes, risks, and benefits of surgery versus conservative management. They can provide personalized advice based on your specific situation and help you make an informed decision about your treatment.

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