Post-Surgery Care Challenges for Scaphoid Fractures: Pain and Recovery

Postoperative care issues for scaphoid fracture of the right wrist?

Hello Doctor: I was involved in a car accident on October 27, 2019, which resulted in a fracture of my right scaphoid bone.
At that time, the emergency physician did not diagnose it, so I switched hospitals and was finally diagnosed four months later (March 6, 2020), after which I underwent internal fixation surgery with screws.
Three months post-surgery, the operating physician said that the healing was satisfactory.
After removing the cast, I underwent rehabilitation for about three months, but the range of motion has not fully returned, and I still experience pain at certain angles (especially when bending my thumb down; moving my thumb while it is flat does not cause pain).
What could be the reason for this? My X-ray shows that the upper and lower halves of the scaphoid bone are not perfectly aligned, with the upper part displaced about 0.1 cm to the right.
Could this misalignment be the cause of my pain? After three months of rehabilitation without improvement, am I destined to experience pain forever? Will I be able to continue weight training in the future?

Liu Kuai Le, 30~39 year old female. Ask Date: 2020/09/08

Dr. Chen Bochen reply Orthopedics

1.
Scaphoid fractures are prone to nonunion, especially when diagnosed later.
2.
Surgery does not guarantee healing (but the likelihood of healing is higher compared to non-surgical treatment).
3.
Healing with a slight discrepancy of a few millimeters usually does not cause pain; however, significant malunion, injury to the surrounding ligaments of the scaphoid, or true nonunion are the main concerns.
It is recommended to consult an orthopedic hand surgeon for further evaluation, which may require MRI (to assess the surrounding ligaments) and CT scan (to rule out nonunion and clarify the alignment).
Wishing you a speedy recovery.

Reply Date: 2020/09/08

More Info

Post-surgery care for scaphoid fractures can be quite challenging, especially when complications arise during the healing process. Your experience with a delayed diagnosis and subsequent surgery for a scaphoid fracture is not uncommon, as these types of fractures can sometimes be difficult to detect initially. The scaphoid bone, located in the wrist, is particularly susceptible to avascular necrosis due to its unique blood supply, which can complicate recovery if not properly managed.

From your description, it seems that you are experiencing persistent pain and limited range of motion even after several months of rehabilitation. The fact that your X-ray shows a slight displacement (0.1 cm) of the scaphoid bone could indeed be contributing to your ongoing discomfort. Misalignment of the bone can lead to improper healing, which may result in chronic pain or dysfunction. This is particularly true for the scaphoid, as even minor misalignments can affect wrist mechanics and lead to pain during certain movements, such as flexing the thumb.

The pain you experience when bending your thumb, especially in a downward motion, may be indicative of several issues. It could be related to the alignment of the scaphoid, as you mentioned, or it could also involve soft tissue structures around the wrist, such as ligaments or tendons, which may have been affected during the injury or surgery. Scar tissue formation from the surgery can also contribute to discomfort and limited mobility.

Regarding your concerns about whether you will experience pain indefinitely, it is difficult to predict without a thorough evaluation by your orthopedic surgeon. However, many patients do experience some level of discomfort after a scaphoid fracture, particularly if there was any misalignment during the healing process. It is essential to communicate your ongoing pain to your healthcare provider, as they may recommend further imaging studies or even a second opinion to assess the healing of the bone and the surrounding structures.

As for your ability to return to weight training and other physical activities, this will largely depend on the resolution of your pain and the restoration of your wrist's function. It is crucial to follow a rehabilitation program tailored to your specific needs, which may include physical therapy focused on strengthening and improving the range of motion in your wrist. Your therapist can also provide guidance on how to safely return to weight training, ensuring that you do not exacerbate your condition.

In summary, the challenges you are facing post-surgery for a scaphoid fracture are not uncommon, and they can stem from a variety of factors, including misalignment of the bone, soft tissue involvement, and scar tissue formation. It is vital to maintain open communication with your healthcare provider about your symptoms and concerns, as they can help guide you through the recovery process and determine the best course of action for your rehabilitation and return to physical activities.

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