Slow Bone Healing: Insights on Wrist Injuries and Treatment

Delayed bone healing?

I underwent surgery for a scaphoid fracture in my right wrist, where screws were used for fixation.
Earlier this year, I accidentally twisted my wrist violently while working, which caused an injury.
Initially, the pain was intermittent, so I didn't pay much attention to it.
Recently, however, I have been experiencing persistent pain in my wrist and a sensation of bone displacement, prompting me to visit the hospital.
After examination, the doctor indicated that the lateral ligaments of my wrist were injured, and X-rays showed that the screws were loose.

The doctor suggested two options:
1.
Surgery to replace the screws and apply a cast for 6 to 8 weeks.
2.
Non-surgical treatment with a cast, which would need to be worn for more than 2 months, depending on the healing of the bone.
I opted for the non-surgical route and have had the cast on for two months now.
During my recent follow-up, the doctor noted that the bone is healing very slowly and replaced the cast.
I have a follow-up appointment next month.

I would like to ask Dr.
Shi the following questions:
1.
If there is still no healing at my next follow-up, does that mean it will not heal at all?
2.
Is it possible for the bone to heal with just a cast?
3.
Generally, how long after applying a cast can it be considered that the bone is not healing?
4.
After how many months of casting without healing would it be appropriate to consider surgical intervention to fix the injury with screws?
Thank you, Dr.
Shi, for your response.

A Yi, 30~39 year old female. Ask Date: 2015/07/31

Dr. Shi Guozheng reply Orthopedics

If there is no healing after three months of treatment, it may be considered non-healing, and surgical intervention could be considered.

Reply Date: 2015/07/31

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding your wrist injury and the slow healing process. It sounds like you have been through a challenging time with your right wrist, especially after the initial surgery for the scaphoid fracture. Let’s address your questions one by one.

1. If the next appointment still shows no healing, does that mean it won’t heal?
Slow healing does not necessarily mean that the bone will not heal at all. Factors such as blood supply to the area, the extent of the injury, and your overall health can influence the healing process. If there is still no sign of healing after a reasonable period, your doctor may consider further imaging studies or alternative treatments.

2. Can the bone heal with just a cast?
Yes, many fractures can heal successfully with conservative treatment such as casting. The key is to ensure that the fracture is properly aligned and that you are following your doctor's instructions regarding immobilization and activity restrictions. However, if the healing is significantly delayed, surgical intervention may be necessary.

3. How long does it typically take for a cast to indicate that the bone is not healing?
Generally, if there is no sign of healing after 8 to 12 weeks of immobilization, it may be considered a non-union. However, this can vary based on the specific fracture and individual healing factors. Your doctor will assess the situation based on follow-up X-rays and your symptoms.

4. How long after casting without healing should surgery be considered?
If there is no evidence of healing after 12 weeks of casting, your doctor may discuss surgical options, such as internal fixation with screws, especially if the fracture is displaced or unstable. The decision will depend on the specific circumstances of your injury and your overall health.

In addition to these points, it is essential to consider factors that may affect bone healing, such as nutrition, age, and underlying health conditions. Adequate calcium and vitamin D intake, along with a balanced diet, can support bone health. If you have any underlying conditions, such as osteoporosis or hormonal imbalances, these may also impact your healing process.

Moreover, if you are experiencing significant pain or discomfort, it is crucial to communicate this with your healthcare provider. Pain can sometimes indicate complications such as non-union or malunion of the fracture, which may require different management strategies.

Lastly, I encourage you to maintain open communication with your healthcare team. They can provide personalized advice based on your specific situation and help you navigate your treatment options effectively. If you have further questions or concerns, do not hesitate to reach out to your doctor.

Wishing you a smooth recovery and the best of health.

Sincerely,
Doctor Q&A Teams

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