The scaphoid is the most important of the 8 small bones in the wrist and is the most common fracture. If left untreated, it can lead to serious problems.
What is the Scaphoid Bone and What Is Its Function?
Wrist; It is the most capable joint of our body with its capacity to perform complex movements. The 8 small bones show many position changes among themselves even during a simple movement. The basic building block of this entire organization is the bone called the scaphoid. In other words, almost all movement and position changes occur over the scaphoid bone. This explains why the extent of pain and loss of function after fracture is so high.
What Happens in Scaphoid Fractures?
Diagnosis and treatment of scaphoid fractures is a difficult process. To summarize the difficulties that may be experienced:
- After the scaphoid fracture occurs, the diagnosis may not be made or the diagnosis may be missed. The fracture may not be observed in the films (direct X-ray) taken after the physical examination after the fracture has occurred. This is a condition specific to the scaphoid bone. In addition, more detailed information can be obtained with Computed Tomography (CT) and Magnetic Resonance (MR) examinations. The best approach at this stage is to pretend that there is a fracture and to apply a splint that will keep the wrist motionless for 2-3 weeks. At the end of this period, radiographs are obtained again. If the fracture has begun to be observed, the patient does not lose time in the treatment, as the time spent immobile with the splint will be added to the treatment period.
- Scaphoid fracture usually hardly heals. There are various reasons for this situation:
- For a fracture to heal, the amount of blood reaching the bone must be within normal limits. Due to its scaphoid bone structure, it is not a bone with good vascularity and blood supply. After the fracture, this situation becomes even more evident.
- As mentioned before, the scaphoid is a bone that is constantly moving and shifting. Although it is tried to be kept still with treatment methods such as plaster, splint, etc. after the fracture, it is usually not possible to prevent small movements.
- The fracture formed in the scaphoid bone remains inside the joint. This situation causes the fracture surface to be in contact with the joint fluid and the clot that will heal the fracture cannot form.
- After the scaphoid bone is broken, one of the broken pieces may die. This condition is called avascular necrosis or aseptic necrosis. Bone death is observed much more frequently after scaphoid bone fractures than other bone fractures. The factors here are generally the same as those just mentioned:
- Problems with blood supply to the scaphoid bone,
- There is a fracture in the joint,
- Fracture movement cannot be prevented,
- Another factor is related to the size of the fragments formed after the fracture. If the bone is divided into relatively equal parts, the probability of bone death in one of the parts is less. If one of the pieces is very small and adjacent to the joint, the risk of bone death is much higher.
How to Diagnose Scaphoid Bone Fracture
At the stage of diagnosis, the patient's history, physical examination findings and direct radiographs are the main sources of information. In case of difficulties in diagnosing or planning treatment with these resources, advanced examinations such as CT and MRI can be applied.
How is Scaphoid Bone Fracture Treatment Applied?
Plaster treatment: Despite all the negativities described, some scaphoid bone fractures are treated. fractures respond positively to the non-surgical treatment we call conservative. These types of fractures are usually transverse and near the middle of the scaphoid bone, and it is possible to apply a plaster cast. The necessity of applying the plaster for at least 12 weeks (with a control record in the sixth week) brings many problems such as daily life quality and hygiene. Intolerance to the above-mentioned possible negativities is also a realistic reason for surgical intervention. It should be noted that very few scaphoid fractures are suitable for treatment with plaster casts.
Surgical treatment: With the surgical treatment, the broken bone is returned to its former anatomical position (pre-fracture state) and is fixed with a number of devices to keep it in this position until it fuses. This intervention is called 'open reduction-internal fixation'. Screws specially developed for this type of fracture are the most commonly used fixation devices.
Late diagnosis complicates the treatment process and prolongs the recovery period!
Diagnosis The treatment process is much more difficult in patients who have been admitted or admitted late. As mentioned earlier, the scaphoid bone is a structure that takes part in all movements of the wrist joint. Deterioration of the integrity of the bone after fracture adversely affects the entire wrist biomechanics. Bones begin to shift spontaneously over time and collapse occurs in the wrist joint. Such situations are often referred to as 'calcification'. This whole process is usually spread over time, so the types of surgical treatment that can be applied are different.
- Fixing and grafting: Fracture is detected, grafting is applied to encourage union. Even if union is achieved at this stage and the normal dimensions of the scaphoid bone are preserved, the damage that has occurred over time cannot be restored. The patient's pain is expected to decrease. It is difficult to predict how much the loss of wrist movement will return
- Rescue interventions: Methods that can be applied in late diagnosed cases where one or all findings such as nonunion, bone death (avascular necrosis), abrasion (calcification) are observed after scaphoid fracture . With these methods, the normal anatomy and biomechanics of the wrist joint are not preserved. It is aimed to preserve the joint movements relatively painlessly by removing the entire scaphoid and the two adjacent bones. Your tests will be requested. The aim here is not only diagnosis but also staging of the fracture. The stage of the disease is of great importance in the selection of the surgical method to be applied. Most of the surgeries related to the scaphoid bone can be performed under regional anesthesia. After surgery, a cast or splint will usually be applied to the elbow joint. The duration of the plaster or splint can vary between 3 weeks and 3 months, depending on the surgical method applied. At the end of this period, physical therapy and rehabilitation are applied. The aim is to gain strength in the hand, wrist and arm and to minimize the loss of movement. High (RSD), late or no expected results are the first things that come to mind. It should be kept in mind that the treatment of scaphoid fracture is a laborious and long period that will take months. Sometimes, the need for a second surgical intervention may arise due to failure to achieve union.
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