Introduction
The aim of surgery is to restore the normal anatomy of the scaphoid bone and to fix it solidly. This will minimise problems such as non-union or avascular necrosis or arthritis.
Indications
Surgery is recommended for:
- Displaced fracture.
- Fractures which do not heal with non-surgical treatment.
- Fractures which are closer to the wrist (proximal pole).
- Athletes and in anyone where earlier return to activities is desired (e.g.: manual labourers).
Procedure
The surgery is under general anaesthesia and is performed as day only in hospital.
Surgery is most commonly performed through a small incision. Here, the bone fragments are lined up and fixed with a screw to form a solid unit. This will compress the fragments against each other to promote healing.
An x-ray is taken during the operation to ensure the bones are back in normal position and that screw is placed correctly.
Recovery
- Day surgery.
- Start gentle wrist movement 0-2 weeks within surgery.
- Drive at approximately 2 weeks.
- Office / admin work at approximately 2 weeks.
- Sports and manual labour can commence as early as 4-6 weeks in some cases.
Results
Majority of patients get their full movement and strength back around 3 months from surgery and return to normal activities after surgery.
The risks of poor / slow healing are higher in smokers.
Risks and complications
These include:
- Non-union. Approximately 5-10%. Higher in smokers.
- Avascular Necrosis.
- Infection <1%.
- Stiffness.
- Wrist Arthritis – If the fracture fails to heal properly.