When its been this long before starting treatment, the bone is done healing, and a screw is just not enough to hold the ends together. In that case, the scaphoid has healed out of position, bent forward (called a humpback deformity), or the row of wrist bones are out of alignment (DISI deformity, see talk). The patient or the Emergency Room thinks “oh the wrist just got whacked, it'll be fine” and then it doesnt get treated any further until the wrist is aching every day. Sometimes doctors don’t even see people until weeks or months after they injure their wrist because the initial break was completely missed and mistaken for a sprain (remember these are notoriously hard to diagnose). One last issue is the unfortunate scaphoid fracture that gets missed initially and is not immediately treated. If you get surgery and return to sports quickly, it takes your bone a little longer to fully heal but it will heal at the same rate as someone that wears a cast for a few months and stays away from activity. Surgery stabilizes the broken bone so they can return to sports within a few weeks (once they have good strength and no pain in the wrist). Its therefore not uncommon for athletes to have surgery on their wrist even when its just a hairline crack at the scaphoid waist. And young people are pretty impatient, especially young people that play sports and dont want to miss their senior year season or a big tournament in 8 weeks. The outcome of surgery is usually very good (about 90% chance of full healing).īut this break usually occurs in active young people. By pushing the broken ends back together with a small screw, doctors hope to stimulate healing and increase the chance that the ends fuse together. Thats a tiny amount of "displacement" but remember that the blood supply to this bone is not good and theres a high risk these two ends never join together without a surgery. But which ones? Breaks that occur at the Scaphoid Waist are at risk of damaging the blood supply to the bone and are therefore treated very aggressively (meaning: high chance for surgery). Most Hand Surgeons will say that surgery is recommended If the scaphoid breaks and the bone fragment move more than 1 milimeter apart. These are often little fractures, but require Big treatment. How is a Broken Wrist (Scaphoid Fracture) treated? The initial treatment for all broken scaphoids is to put the wrist into a splint (called a thumb spica splint) as soon as the injury is identified. If the break is seen clearly, then many doctors will get a CAT scan (which is great for showing details of the scaphoid bone) in order to plan for surgery (more on this below) If a person cannot get an MRI, they can follow up in 2-3 weeks for a repeat x-rays, which will often show a break at this time (the crack will show up 2 weeks later because bone remodels itself while healing and it actually removes the bone fragments before it starts to fill in the crack with new bone. Sometimes, there is a big break, its easily seen on x-ray because the bone fragments have moved far apart. Its important to be overly cautious when this injury is suspected if its not treated correctly from the start, theres a higher risk it wont heal correctly. This means putting on a cast that protects the bone, and then getting an MRI of that wrist (an MRI is good at showing very very small cracks in the bone) a few days later. If symptoms suggest a broken scaphoid, the injury should be treat as one, even if its not seen on xray. But overall its critical for doctors to be very suspicious for this injury based on a person's symptoms. Sometimes a special scaphoid view x-ray (with the wrist extended and ulnar deviated) can help show the break. The next step is to get x-rays. But this injury is notorious for not appearing on x-rays because the break is often too small to notice. A person will usually complain of pain behind their thumb (called "snuffbox tenderness"), and pain with grip. How is a Broken Wrist (Scaphoid Fracture) diagnosed? Diagnosis of this fracture can be a challenge.
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