Scaphoid fracture & non-union
What is Scaphoid fracture & non-union?
The scaphoid is a small wrist bone with a vulnerable blood supply. Fractures can be difficult to see initially and may fail to heal, creating a non-union that can lead to wrist collapse and arthritis.
Common symptoms
Pain is usually felt on the thumb side of the wrist, especially in the anatomical snuffbox. Grip, lifting, pushing through the hand and wrist extension can be painful. Symptoms may be mild despite a significant fracture.
Diagnosis and imaging
X-rays are the starting point, but early fractures can be missed. CT defines fracture displacement and healing. MRI can detect occult fracture and assess blood supply when X-rays are normal but suspicion remains high.
Non-surgical treatment
Stable, non-displaced fractures may be treated in a cast or brace with close imaging follow-up. The decision depends on fracture location, displacement, patient demands and the likelihood of healing.
Surgical treatment
Surgery is considered for displaced fractures, proximal pole fractures, high-demand patients or established non-union. Options include screw fixation and bone grafting, with vascularised grafts considered when blood supply is compromised.
Recovery and follow-up
Healing can be slow. Immobilisation or protection is maintained until union is demonstrated. Return to sport or manual work depends on CT evidence of healing, comfort and strength.
Scaphoid fracture & non-union FAQs
Why are scaphoid fractures easily missed?
Early X-rays can look normal and pain may be modest. Persistent thumb-side wrist pain after a fall should be treated seriously.
How is scaphoid fracture & non-union diagnosed?
Diagnosis starts with a focused history and examination, then uses imaging selectively to confirm the pattern of injury, exclude related problems and plan treatment accurately.
What is a scaphoid non-union?
It means the fracture has not healed. Non-union can change wrist mechanics and increase the risk of progressive arthritis.
Will I need surgery for scaphoid fracture & non-union?
Many patients improve without surgery. Surgery is considered when symptoms remain limiting despite appropriate non-surgical care, when there is significant structural damage, or when delay may compromise function.
When can I return to contact sport or manual work?
Return depends on the diagnosis, treatment type, tissue healing and the physical demands of the activity. The plan is usually staged, with strength, range of motion and confidence rebuilt before unrestricted loading.
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