Scaphoid Fractures: Healing Challenges and Recovery Insights

Scaphoid fracture with nonunion?

I went to the emergency room on May 3rd due to a car accident, and at that time, no fractures were detected in my hand.
Subsequently, I received injections, medication, and rehabilitation treatment at a clinic for my hand discomfort.
However, on June 3rd, since my symptoms did not improve, I had another X-ray, which revealed a scaphoid fracture with nonunion.
I was referred to an orthopedic hospital and underwent fracture reduction and internal fixation surgery on June 19th, using headless screws for fixation and a cast on my left palm.
The cast was on for about five weeks.
Recently, on July 25th, the cast was removed, but I am experiencing stiffness in my fingers, inability to bend my thumb, swelling in my palm, and a tingling sensation near the center of my palm close to the thumb.
Are these symptoms normal? (Especially the tingling sensation in the palm.) When can I expect these symptoms to improve?

Ms. Li, 50~59 year old female. Ask Date: 2023/07/26

Dr. You Dianqi reply Orthopedics

After the removal of the fixation, rehabilitation is necessary.
You may consult the rehabilitation department for rehabilitation matters.
If you have any other concerns, it is recommended to return for a consultation with your original treating physician.
Thank you.

Reply Date: 2023/07/26

More Info

Scaphoid fractures, particularly those that are non-union or have healing challenges, can present a complex clinical scenario. Your experience of initially not having the fracture detected and later undergoing surgery for internal fixation highlights a common issue with scaphoid injuries, which can often be subtle on initial X-rays. The scaphoid bone, located in the wrist, is particularly prone to complications due to its unique blood supply, which can lead to avascular necrosis if not properly managed.

After your surgery on June 19, where a headless screw was used for fixation, it is not uncommon to experience stiffness, swelling, and sensory changes in the hand, especially in the thumb and palm area. These symptoms can be attributed to several factors:
1. Post-Surgical Swelling: After surgery, swelling is a normal response as the body heals. This can lead to a feeling of tightness and discomfort in the surrounding tissues. Elevating your hand and using ice can help manage this swelling.

2. Stiffness: The immobilization period with a cast can lead to stiffness in the joints and soft tissues. This is particularly common in the thumb and fingers after prolonged immobilization. Gentle range-of-motion exercises, as advised by your physical therapist, can help improve flexibility and function.

3. Nerve Sensation Changes: The "tingling" or "numbness" you are experiencing in the palm near the thumb could be due to nerve irritation or compression, which can occur during the healing process or from the positioning of the cast. This sensation should gradually improve as swelling decreases and nerve function returns to normal.

4. Recovery Timeline: The timeline for recovery can vary significantly among individuals. Generally, after the removal of the cast, it may take several weeks to months for full range of motion and strength to return. Engaging in physical therapy can be beneficial in this phase to facilitate recovery.

5. When to Seek Further Evaluation: If the numbness persists or worsens, or if you experience significant pain, it is crucial to follow up with your orthopedic surgeon. They may want to perform additional imaging studies to assess the healing of the scaphoid and rule out any complications such as non-union or avascular necrosis.

In summary, while some degree of stiffness and sensory changes can be expected after scaphoid fracture surgery, it is essential to monitor your symptoms closely. Engaging in a structured rehabilitation program under the guidance of a qualified therapist can significantly enhance your recovery. If you have concerns about your symptoms or if they do not improve over time, do not hesitate to reach out to your healthcare provider for further evaluation and management.

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