Treatment depends on the location, fracture type, and fracture location in the bone. Fractures located near the thumb (distal pole) heal well with casting. Fractures in areas with a poor blood supply and displaced fractures generally require surgery.
If the fracture is identified immediately and is in good alignment, you will probably wear a cast for nine to twelve weeks. The cast will cover your forearm, wrist and thumb. This is necessary to hold the scaphoid bone very still while it heals. Your doctor will take x-rays at least once a month to check the progress of the healing. Once your doctor is sure the fracture has healed, the cast will be removed. Even with this type of treatment, there is still a risk that the fracture may not heal well and will become a non-union.
A fracture that doesn’t heal within several months is considered a non-union. If the injury is fairly recent, your doctor might recommend more time in the cast. He or she might also prescribe an electrical stimulator. The electrical stimulator is a device that sends a small electrical current to your scaphoid bone. You wear it like a large bracelet for 10 to 12 hours a day. Electrical current has been shown to help the bones heal.
Surgery for scaphoid fractures can be done through a tiny incision when the bone fragments do not need to be reduced (manipulated). Otherwise, a relatively small incision at the base of the thumb is needed. The surgical approach is determined by the fracture location in the bone. Headless screws, of which there are several types, are used to hold the scaphoid bone in position while it heals. A cast or splint is worn for some time following surgery.
Screw Fixation – Some surgeons report good results doing surgery right away when a patient has had a recent, non-displaced scaphoid fracture. Studies have shown that this method can help people get back to activity faster than wearing a cast for up to 12 weeks. The procedure involves inserting a screw through the scaphoid. The screw holds the scaphoid firmly until it heals and often can be inserted through a very small scar.
Scaphoid Debridement – In cases where a non-union has occurred despite appropriate treatment, surgery will likely be suggested. An incision is made in the wrist directly over the scaphoid bone. Depending on the exact location of the non-union the scar may need to be on the palmar side of the wrist or on the back of the wrist. The surgeon finds the old fracture line on the scaphoid bone and all the scar tissue between the two halves of the bone must be removed (debrided). This creates a fresh bone surface to allow healing to begin again. In some cases, damaged bone tissue from the scaphoid is also removed and stability and compression of the two fragments is achieved with a screw.
Bone Graft Method – Your surgeon may use a bone graft. A bone graft involves taking bone tissue from another spot in your wrist and inserting it into the fracture. A bone graft can stimulate healing on the surface of the bones. Sometimes it is necessary to take the bone graft from the brim of your pelvic bone if it is necessary to alter the shape of the scaphoid in the presence of a longstanding non-union.
Sometimes the bones still do not heal as planned. Surgeons call a fused bone that fails to heal a pseudarthrosis. If the non-union continues to cause pain, you may need a second operation. Your surgeon will probably add more bone graft and check that the pins or screws are holding the bones together.
Depending on the type of surgery you have, you may be placed in a splint for up to 12 weeks after surgery. Your surgeon will x-ray the wrist several times after surgery to make sure that the bones are healing properly. Once the two halves of the scaphoid bone have healed, you can safely begin a rehabilitation program.