Treatment is personalised to you
Treatment depends on the location, fracture type and how long ago the injury occurred. Fractures located near the thumb (distal pole) heal well with casting, others in areas with a poor blood supply and displaced fractures generally require surgery.
Surgery for scaphoid fractures can be achieved via 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 there are several types, are used to hold the scaphoid bone in position while it heals and a cast or splint is worn for some time following surgery.
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Wearing a cast
If the fracture is identified immediately and is in good alignment, you will probably wear a cast for 9 to 12 weeks. The cast will cover your forearm, wrist and thumb which is necessary to hold the scaphoid bone very still while it heals. Your specialist will take X-rays at least once a month to check the progress of the healing and the cast will be removed once the fracture has healed. Even with this type of treatment, there is still a risk that the fracture may not heal well and could potentially become a non-union.
Electrical stimulator for non-union
A fracture that does not heal within several months is considered a non-union. If the injury is fairly recent, your specialist might recommend more time in the cast or they may also prescribe an electrical stimulator. This device sends a small electrical current to your scaphoid bone and it is worn like a large bracelet for 10 to 12 hours a day because electrical current has been shown to help bones heal.
Conservative treatment methods
- Wearing a cast
- Electrical stimulator for non-union
Some surgeons report good results performing 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 and work 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 incision.
In cases where a non-union has occurred despite appropriate treatment, surgery will likely be suggested. Depending on the exact location of the non-union the incision is made in the wrist directly over the scaphoid bone either on the palmar side of the wrist, or on the back of the wrist. The surgeon will find the old fracture line on the scaphoid bone and will remove all of the scar tissue between the two halves of the bone (debrided). This will create 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 firmly held with a screw.
Bone graft method
Your surgeon may use a bone graft which involves taking bone tissue from another spot in your wrist and inserting it into the fracture this procedure can stimulate healing on the surface of the bones. Sometimes, in order to alter the shape of the scaphoid in the presence of a longstanding non-union, a bone graft will be taken from the brim of your pelvic bone.
If the bones do not heal as planned (pseudarthrosis) and 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 programme.
Surgical treatment methods
Bone graft method