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Treatment – Cause – Surgery

Scaphoid fracture

A scaphoid fracture, also called a scaphoid fracture, is usually caused by a fall on the hand. In some cases it is sufficient to treat the fracture conservatively, i.e. without surgery, and immobilize it by means of a plaster cast. Since complications – for example, scaphoid pseudarthrosis – can occur with this method, there are also many surgical options to treat the scaphoid fracture. Find out everything you need to know about scaphoid fracture in this article by the specialist in trauma surgery and orthopedics, OA Dr. Simon Sailer. Scaphoid fracture treatment expert talks about symptoms, causes as well as various treatment options available for scaphoid fracture. You should always have symptoms of a scaphoid fracture clarified by a specialist. If a scaphoid fracture is not recognized or is treated incorrectly, it can result in scaphoid pseudarthrosis. “If surgery is necessary, patients and doctors should take advantage of bone screws (screws made from human bone) to treat the scaphoid,” says the expert from Tyrol / Austria.

Reading time: 5 min

Author of the article: OA. Dr. Simon Sailer
Dr. Simon Sailer is a specialist in trauma surgery and orthopedics at Schwaz Hospital in Tyrol. He is a specialist in hand surgery and here he specializes, among other things, in the treatment of the scaphoid bone.
Updated 17.01.2023

Scaphoid - what is it?

Scaphoid is the name given to two bones in the human skeleton. The carpal bone (Os scaphoideum) and the tarsal bone (Os naviculare). However, when one speaks of the scaphoid or the scaphoid, one predominantly means the carpal bone. The scaphoid can be divided into three sections: the proximal, middle, and distal scaphoid thirds. If a fracture occurs, known as a scaphoid fracture, it usually breaks in the middle section. Less frequently, a scaphoid fracture occurs in the proximal section and most rarely in the distal section

By the way, the scaphoid fracture is the most common fracture of a bone at the carpus. Often screws made from human bone / bone screws are used in surgery. Surgical metal removal thus becomes unnecessary.

The scaphoid fracture

A scaphoid fracture usually requires surgical treatment. The ends of the fracture are stabilized with a screw made of human bone. The reason for a scaphoid fracture is usually a fall on the outstretched hand, as the entire force is transferred to the forearm via the carpal bones, which can cause the scaphoid to fracture. A scaphoid fracture can be divided into 6 different classes:

  • C1 – avulsion or avulsion fracture
  • C2 – horizontal / transversal fracture
  • C2.1 – Fracture of the distal third
  • C2.2 – Fracture of the middle third
  • C2.3 Fractures of the proximal third
  • C3 – vertical or multi-fragment fracture

Die Klassifizierung des Bruchs lässt Rückschlüsse auf die Durchblutung der Bruchfragmente, und somit die Heilungschancen zu. The exact identification of the fracture line and the blood flow situation is crucial for the subsequent treatment. “The chance of healing is best with particularly distal fractures, because that’s where the better blood supply is. Depending on the fracture, the patient decides together with the scaphoid specialist whether surgery is necessary,” explains scaphoid expert Dr. Sailer. If surgery is decided upon, the scaphoid is stabilized in many cases with a screw made from human bone. “Recent studies show that screws made from human bone work very well. This is due to the fact that the bone screw is colonized by the patient’s own cells and remodeled into the patient’s own bone,” says scaphoid expert OA Dr. Simon Sailer.

Treatment of scaphoid fracture

A scaphoid fracture can be treated both conservatively and surgically. Conservative treatment eliminates risks that can occur with surgery, but healing takes longer and the risk of pseudarthrosis formation is increased. Which of the two methods is used depends, among other things, on the part of the scaphoid in which the fracture runs. Clarify with an expert which treatment is right for you and whether bone screws can be used.

The operation of a fresh scaphoid fracture

In many cases, the scaphoid fracture requires surgery. During scaphoid surgery, the two bone fragments are fixed to each other. There are many ways to connect the bone pieces, so metal screws can be used but also screws made from human bone like the Shark Screw®. The advantage of the Shark Screw® is that it is integrated into the bone remodeling process of the patient’s own body and is thus remodeled into the patient’s own bone.

Surgical materials in scaphoid fracture & scaphoid pseudarthrosis.

Material

Vorteile

Risiken

Shark Screw® / Schraube aus menschlichen Knochen

Integration in Knochenumbauprozess | Keine Metallentfernung | Keine Wetterfühligkeit bekannt | Geringe Schmerzen nach der Operation | Hohe Festigkeit

1-4 Wochen nach der Operation besondere Vorsicht bei der Belastung des Fußes

Schrauben aus Metall / Metalllegierungen

Hohe Festigkeit

Kann Gewebeirritationen hervorrufen, Einsatz bei Allergien nicht empfohlen | Metallentfernung wahrscheinlich da Gewebe (Sehnen & Bänder) gereizt werden könnten

Plattensysteme

Hohe Stabilität und Festigkeit

Kann Gewebeirritationen hervorrufen | Einsatz bei  Allergikern & Wetterfühligkeit vermeiden
| Metallentfernung wahrscheinlich 

Resorbierbare Schrauben

Lösen sich im Körper auf | Kein Metall im Körper

Können Gewebeirritationen aufrufen | Geringe Stabilität | Auflösungsprozess kann Schmerzen oder Resorptionszysten hervorrufen.

Shark Screw® & Scaphoid Facture

“Many doctors rely on the screw made from human bone – the Shark Screw® – for scaphoid fracture surgery. The fundamental advantage of the Shark Screw® is that it is integrated into the natural bone remodeling process. As soon as the Shark Screw® is inserted into the bone, it is colonized by the body’s own cells. The so-called Havers channels inside the screw make this possible. Bone cells and the body’s own vessels can settle in these channels of the Shark Screw® and thus contribute to the formation of new bone structures that eventually become the patient’s own bone,” explains orthopedist Dr. Klaus Pastl from Linz, who has been studying bone healing in humans for decades. This often saves patients a second procedure, namely metal removal. However, if no additional surgery is necessary due to the Shark Screw®, the associated risks for the patient as well as the duration of sick leave are enormously reduced.

Aftercare of a scaphoid fracture

There may be swelling in the operated area for the first few days after scaphoid surgery. The duration of immobilization depends on the degree of the fracture. Normally, however, weight bearing should be possible again 6 – 12 weeks after the operation. A total post-treatment period of 3 – 5 months is to be expected. If a metal implant is used during the operation, it may have to be removed again during a new operation. If the metal is not removed, it remains in the patient’s body for life.

Symptoms of scaphoid fracture

Typical symptoms of a scaphoid fracture are occurring pain in the regions of the back of the hand and the thumb, especially during movement and strain of the wrist. This leads to a gentle posture. Restrictions occur in simple movements such as holding a cup or brushing teeth. Another typical sign is a pressure pain at the wrist on the extensor side of the thumb.

The scaphoid pseudarthrosis treatment & experience

“The risk is present in all scaphoid fractures: Scaphoid pseudoarthrosis. In scaphoid pseudoarthrosis, the individual pieces of the fracture do not grow together in a stable manner. This leads to the fact that bone fragments remain mobile and thus a “false joint” is formed,” says the expert from Tyrol OA Dr. Simon Sailer. Scaphoid pseudoarthrosis usually occurs when a scaphoid fracture has not been treated consistently enough or has not been recognized. Thus, only scar tissue forms between the bone fragments, but no stable bony connection. Patients often experience pain from scaphoid pseudarthrosis. In addition, the incorrect position of the scaphoid damages the adjacent joints. The risk of pseudoarthrosis formation is higher with conservative treatments than with surgical treatments. In any case, a specialist should be consulted for the treatment of scaphoid pseudarthrosis!

Surgery & cure for scaphoid pseudarthrosis

Option 1: Shark Screw® | Percutaneous Care

Option 2: Shark Screw® + allograft (donor bone) | Open procedure possible

Option 3: Plate made of metal + bone from own pelvis (autograft own bone) à pain due to the removal of the bone in the pelvis often longer than pain in the hand | open procedure

Option 4: Pedicled flap (autograft own bone) + metal screw or metal plate à Own bone with blood vessels from the pelvis, tibia or forearm à Often very severe pain for patient | Open procedure | Long surgery times

Verfahren

Vorgangsweise

Vorteile

Nachteile / Risiken

Shark Screw® / Schraube aus menschlichen Knochen

Meist kleiner Hautschnitt

Integriert sich in den natürlichen Knochenumbauprozess

Hohe Stabilität, Rotationsstabilität

Derzeit keine bekannt

Shark Screw® + Allograft

Auffüllung des Defektes mit Spenderknochen

Keine Entnahmeschmerzen wie bei Autograft im Becken oder Tibia. etc. Hohe Stabilität, Rotationsstabilität

Derzeit keine bekannt

Platte aus Metall + körpereigener Knochen

Körpereigener Knochen wird aus Becken entnommen

Hohe Stabilität

Oft mit Schmerzen verbunden durch Entnahme des Knochens aus dem Becken | längere Schmerzen in der Nachbehandlung & Risiko einer Metallentfernung gegeben

Gestielter Lappen + Metallschraube oder Metallplatte

Körpereigener Knochen mit Blutgefäßen wird aus Becken, Knie oder Unterarm entnommen

Anschluss des neuen Knochens an Blutsystem möglich

Große Schmerzen für Patient durch Entnahme des eigenen Knochens möglich, lange Operationsdauer

Late sequelae of scaphoid pseudarthrosis

If scaphoid pseudoarthrosis is not treated, destruction of the articular cartilage by the fragments progresses, which may eventually lead to osteoarthritis. Osteoarthritis can spread throughout the wrist in late stages. To avoid such late damage, be sure to talk to an expert about treatment options.

Cause & Diagnosis of Scaphoid Fracture

Most often, the reason for a scaphoid fracture is a fall on the outstretched hand. The scaphoid is subjected to particularly high forces. For example, it is often young patients who suffer a scaphoid fracture and usually participate in sports that are associated with an increased risk of falling. Men are also six times more likely to suffer from scaphoid fractures than women, although their bone structure is stronger.

To assess whether a scaphoid is broken or not, the specialist always performs clinical examinations on the patient. Often the scaphoid expert can already estimate whether the scaphoid is broken by the so-called scaphoid shift test according to Watson. If he moves his hand in the direction of the thumb, a click is heard and the patient feels pain, a scaphoid fracture is suspected.

In addition to the clinical examination of the scaphoid, an x-ray is usually taken to confirm the suspected diagnosis. Since a scaphoid fracture cannot always be seen with certainty on an X-ray, it may be necessary to resort to computed tomography.

Conservative treatment of scaphoid fracture

If the fracture is not displaced and the fracture line is not in the proximal third of the scaphoid, it is possible to treat the fracture conservatively by immobilization in a cast for 6 – 12 weeks. After 2 -3 weeks, a review of the healing process is performed. A disadvantage of conservative treatment is the long healing process, which can take 2 to 3 months. If pseudoarthrosis (link chapter) is already present, the fracture can no longer be treated conservatively. “In such a case, a fitting with the Shark Screw® is indicated in any case,” advises OA Dr. Simon Sailer.

FAQs

How long does the treatment of a scaphoid fracture take?

How long the fracture takes to heal depends on the particular therapy method and the type of fracture. Thus, the healing process often takes longer with conservative therapies than with surgical therapies. Sometimes a postoperative cast immobilization is necessary for a few weeks.

How to recognize a scaphoid fracture?

Pain occurs in the back of the hand as well as the thumb, especially when moving. Swelling may occur.

How does a scaphoid fracture happen?

The cause of a scaphoid fracture is usually a fall on the outstretched hand. Because of the narrow ligamentous guidance, the bone fragments move only slightly, which is why a scaphoid fracture is often difficult to detect on X-ray.

How is a scaphoid fracture operated on?

The fracture ends are usually stabilized with a screw such as Shark Screw®. Minimally invasive surgery through a 0.5 cm skin incision is often possible.

Can you move your hand if you have a scaphoid fracture?

Most of the time, the wrist can be moved despite a scaphoid fracture. Often, only moderate pain is present, so it is easy for the injury to be overlooked.

Where is the scaphoid bone?

The scaphoid bone is located on the thumb side of the wrist and is one of the 8 carpal bones.

How long do you have to stay in the hospital after scaphoid surgery?

The surgery can be performed as an outpatient as well as an inpatient procedure.

What are the symptoms of scaphoid pseudarthrosis?

Scaphoid pseudoarthrosis may cause little discomfort over a long period of time or may go undetected. If pain occurs during movement, it is usually on the side of the wrist facing the thumb. In the later course, movement restrictions as well as a reduction in strength of the wrist are added. The symptoms should be urgently clarified by a specialist!

The author - OA Dr. Simon Sailer

Dr. Simon Sailer is a specialist in trauma surgery and orthopedics at Schwaz Hospital in Tyrol. He is a specialist in hand surgery and here he specializes, among other things, in the treatment of the scaphoid bone.

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