Scaphoid Fracture Surgery and Recovery Challenges

Lunate bone separation

The screw used to fix the scaphoid fracture in my right wrist has loosened.
Earlier this year, I accidentally twisted my wrist violently while working, which caused an injury.
Since the pain fluctuated, I didn't pay much attention to it.
Recently, due to persistent pain and a feeling of displacement in the wrist bones, I went to the hospital for a consultation.
After examination, the doctor indicated that the lateral ligaments of the wrist were injured, and X-rays showed that the screw had loosened.

The doctor recommended:
1.
Surgery to replace the screw and apply a cast (with the cast fixed for 6 to 8 weeks).
2.
Cast immobilization (for a longer duration of over 2 months, depending on the healing of the bone).
Treatment options:
1.
Not re-locking the screw.
2.
Applying a cast from the wrist to the upper arm.
Current status: During the follow-up visit, the doctor stated that the bone is healing.
I am scheduled to return in two weeks to change to a short cast.
The cast has been on for three months, and in two weeks, it will be three and a half months.
I apologize for asking again, Dr.
Shi:
1.
After switching to a short cast in two weeks, will moving my arm cause the existing screw to loosen again, potentially slowing down the bone healing?
2.
Is it possible to keep the cast extending to the upper arm until the bone is fully healed before removing it? (Is that feasible?) I am concerned about removing the cast too early affecting the bone healing and the wrist becoming unstable after the cast is removed, which might lead to another surgery.
Thank you for your response, Dr.
Shi.

A Yi, 30~39 year old female. Ask Date: 2015/08/26

Dr. Shi Guozheng reply Orthopedics

The physician's recommendation to switch to a short arm cast is reasonable because prolonged use of a long arm cast (extending beyond the elbow joint) can affect the range of motion in the elbow.
This may result in difficulty fully extending or bending the elbow.
Since the bones continue to grow, it is advised to continue monitoring the situation.

Reply Date: 2015/08/26

More Info

Understanding scaphoid fractures and their surgical management can be quite complex, especially when complications arise, such as screw loosening. The scaphoid bone, located in the wrist, is particularly susceptible to fractures due to its location and the mechanics of wrist movement. When a scaphoid fracture occurs, it can lead to significant pain and functional limitations, and if not treated properly, it can result in complications like nonunion or avascular necrosis.

In your case, it appears that you initially sustained a scaphoid fracture due to a twisting injury at work. The fact that you experienced intermittent pain and discomfort before seeking medical attention is not uncommon, as scaphoid fractures can sometimes be subtle and may not always present with immediate or severe symptoms. However, the development of persistent pain and the sensation of bone displacement prompted you to seek further evaluation, which is a crucial step in managing such injuries.

Upon examination, your doctor identified that the external ligaments of your wrist were injured and that the screw used to stabilize your scaphoid fracture had become loose. This is a significant finding, as it indicates that the initial fixation may not have provided adequate stability for proper healing. The treatment options presented to you included either a surgical intervention to replace the screw and re-stabilize the fracture or continued conservative management with prolonged casting.

1. Concerns about Activity and Screw Stability: After your upcoming appointment to switch to a short cast, it is natural to worry about the potential for the screw to loosen again, especially with increased activity. Generally, if the bone is healing well, the risk of screw loosening decreases as the fracture site stabilizes. However, it is essential to follow your doctor's advice regarding activity levels. Engaging in activities that place stress on the wrist before the bone has adequately healed can indeed jeopardize the healing process. Therefore, it is crucial to adhere to the recommended restrictions and gradually increase your activity level as advised by your healthcare provider.

2. Extended Casting Considerations: Your concern about keeping the cast on until the bone is fully healed is valid. While it may seem beneficial to maintain immobilization to ensure stability, prolonged casting can also lead to complications such as stiffness, muscle atrophy, and decreased range of motion. The decision to remove the cast should be based on clinical and radiographic evidence of healing. Your doctor will likely assess the fracture's healing progress through follow-up X-rays and clinical evaluations. If the bone shows signs of adequate healing, transitioning to a short cast may be appropriate to allow for some movement while still providing support.

In conclusion, managing a scaphoid fracture requires careful monitoring and adherence to medical advice. It is essential to communicate openly with your healthcare provider about your concerns and any symptoms you experience. They can provide guidance tailored to your specific situation, ensuring that you achieve the best possible outcome while minimizing the risk of complications. Remember, the healing process can take time, and patience is often necessary as you work towards regaining full function of your wrist.

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