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Scaphoid Fracture Surgery – What Happens If A Scaphoid Fracture Never Heals?

scaphoid fracture x-ray non-union arthritisAn important part of deciding to have surgery for a scaphoid fracture is figuring out what can happen if you don’t have surgery. This article shows you a good example of what happens if a scaphoid fracture never heals.

What is a scaphoid fracture?

A scaphoid fracture is a break or crack through the scaphoid bone of the wrist. It’s on the thumb side of the wrist.

Scaphoid bones usually break when an athlete or young person falls on their hand and wrist, trying to break their fall. The impact hyperextends the wrist, snapping the scaphoid bone in half.

Why are scaphoid fractures bad?

The scaphoid bone has poor blood supply. The arteries that feed it blood enter the bone at strange locations. If the break is in a bad location (usually proximal, or further back away from the fingers), the bone can be very difficult to heal, even if surgery is done.

Most breaks happen in the middle of the bone. If the bone is held in a stable, solid position, it can heal, and does just fine most of the time.

However, sometimes when a scaphoid fracture isn’t recognized – it can be hard to tell the difference between a sprain and a wrist fracture – the wrist stops hurting as bad and the patient keeps using the wrist after a couple of weeks.

This keeps the broken pieces moving together, and the bone never heals.

What happens if the scaphoid never heals?

If the pieces aren’t lined up and held still with a cast or a screw in surgery, the pieces will keep grinding on each other and on the rest of the wrist joint, wearing it out over time.

This type of wear and tear after trauma (or fracture) is a form of arthritis called post-traumatic arthritis.

Here’s an example of an x-ray of a painful left wrist. This man injured his wrist about 40 years earlier and it was never treated surgically or with a cast.

x-ray of wrist arthritis after scaphoid fracture

X-ray of a painful arthritic wrist after scaphoid fracture years earlier.

The white areas between the bone edges are areas of bone-on-bone arthritis where the joint is wearing out.

This type of arthritis can only be treated with removal of the bones or fusion of bones together. This stops the pain of arthritis but limits the normal motion of the wrist.

How can this type of wrist arthritis be prevented?

Wrist arthritis after scaphoid non-union (failure to heal) can be prevented by an appropriate cast or surgery to line up the fragments and keep them still so they can heal together.  Most scaphoid waist fractures (in the middle of the bone) will heal in a cast if the pieces aren’t out of place.

Kendall Marshall, UNC’s star point guard, needed surgery for his scaphoid fracture.

 

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