Scaphoid Fractures and Treatment
Fractures of the scaphoid can be treated conservatively with casting or with open reduction internal fixation. The problem with fractures of the scaphoid is that the scaphoid has poor vascularity and can easily go onto nonunion or avascular necrosis. The outcome will depend how the fracture is managed and how long to presentation to a clinic. Another factor to consider in management is if the fracture is displaced. If the scaphoid is displaced greater than 1mm this will have an impact on treatment.
The scaphoid is divided up into three parts when determining treatment, distal pole, middle (waist) and proximal pole. Depending on how you decide to treat will have an effect on the outcome.
Distal Pole Scaphoid Fractures
Distal pole scaphoid (See Figure1) have the best outcome for healing. The blood supply is better to this part of the bone and the healing time to union is around 4-6 weeks. These fractures are best treated with a thumb spica cast for the 4-6 weeks period than transition to a thumb spica splint and begin occupational/physical therapy to work on range of motion and strengthening. Outcome is good.
Proximal Pole Scaphoid Fractures
These fractures are less frequent and distal pole and waist fractures. 6-20% of scaphoid fractures are in proximal pole. These fractures have very poor vascularity and the probability is high for nonunion. If treated conservatively with no displacement it can take 12-14 weeks of immobilization. Depending on the patient and activity level you may decide to talk with the patient about an ORIF.
Waist Scaphoid Fractures
In our clinic we see quite a few scaphoid fractures and an majority of the fractures are in the middle/waist. If the fracture is not displaced I will give the patient the option of casting vs. ORIF. With an ORIF we can control more of how the fracture will heal. If the fracture is displaced I will explain to the patient why the ORIF is the best option. If the patient chooses immobilization I inform them that they will be casted for 8-12 weeks. If the fracture fails to heal than surgery is the next option.
Treatment will depend on the type of fracture that the patient has, their type of work, activity and financial status. This will help you and the patient decide on what is best for them.
Last edited Tuesday, September 25, 2018