Healing a scaphoid fracture
introduction
As Scaphoid fracture is called the Fracture of one of the carpal boneswhich, topographically, forms the ball of the hand. The healing of a scaphoid fracture is often difficult, because this small bone has a relatively poor blood supply is fed. The navicular bone is not supplied from the center of the body, but in this case with blood vessels that come from the direction of the fingers. In addition, the supplying blood vessels in the navicular bone themselves do not form any connections, so that the rupture of a vessel automatically one Undersupply of the corresponding bone part means. Therefore, fractures in the distal two thirds of the scaphoid near the fingers heal faster and better than in the proximal third near the wrist. The healing of the scaphoid is therefore considered to be challenging and not always successful.
cure
The scaphoid fracture can be healed with or without surgery. How the fracture is treated is ultimately dependent on the type of fracture itself. Fractures in the distal two thirds can be treated conservatively. The distal third is immobilized for about 6-8 weeks.
The middle third should be immobilized for 10-12 weeks due to the poor blood supply. However, after up to 3 months of immobilization, muscles are atrophied and tendons are usually shortened. However, this is done using a consistent physiotherapy and regained some patience after a while. In addition to the restricted range of motion (which usually results directly from the immobilization of the muscles and joints and not from the fracture itself), other residual complaints may initially remain after conservative treatment. These include, among other things Swelling, Numbness in arm and hand and / or a raised one Weather sensitivity.
Surgery is always indicated for fractures of the proximal third. Such a scaphoid fracture should always be screwed. To do this, the two broken fragments are screwed together with a titanium screw. The pressure that acts on the fragments from now on makes them grow together more quickly, like when you glue two pieces of wood together under pressure. The advantage of the operation is that the hand is stable again after just a few days, i.e. can be used freely. The muscles do not degenerate, the tendons do not shorten, and the screw can usually be left in the hand, which rules out further surgery.
The "Herbert screw" was specially developed for treating scaphoid fractures with surgery, a screw that is completely sunk into the bone and exerts an optimal tensile effect on the bone pieces due to the two threads at both ends. It is inserted through a small incision (approx. 1 cm long) on the inside of the wrist, below the ball of the hand. The incision usually heals without any problems, leaving a thin, thin scar.
Appointment with a hand specialist?
I would be happy to advise you!
Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)
In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
In our very economic world in particular, there is too little time to thoroughly grasp the complex diseases of orthopedics and thus initiate targeted treatment.
I don't want to join the ranks of "quick knife pullers".
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
You can find me at:
- Lumedis - orthopedics
Kaiserstrasse 14
60311 Frankfurt am Main
Directly to the online appointment arrangement
Unfortunately, appointments can only be made with private health insurers. I ask for understanding!
Further information about myself can be found at Lumedis - Dr. Nicolas Gumpert
Following a surgery certain complaints can also occur. Because of the fact that during the procedure in the forearm annoy can be irritated, it can also be here too Tingling or numbness the affected areas. These symptoms then disappear completely within a few months, but ultimately also in almost everyone, so that the wrist is just as functional again as it was before the accident.
From time to time, however, it can also happen that the healing process is rather unfavorable. The risk of this is especially high if there is a small piece of bone blasted off which cannot be supplied with sufficient blood and thereby slows down the healing process and makes it more difficult, or if a scaphoid bone fracture takes a long time undetected and therefore untreated remains. Then in some cases one forms Pseudarthrosis of the scaphoid. This means that the bone fragments will not grow back together properly. That then ultimately leads to complaints that one arthrosis resemble. Bone rubs on bone, causing the patient Pain prepares and becomes a restricted agility leads in the joint. In such a case, the indication for a (further) surgical intervention given to prevent the symptoms from becoming chronic and the hand no longer being used properly.
Scaphoid pseudarthrosis
Often, however, a scaphoid bone fracture becomes not recognizedbecause he is mostly relative painless expresses. It may stay on for a few weeks or months slightly painful feeling in the heel of the hand, which, however, does not really matter and is therefore often ignored. Of course, not every bruise of the heel of the hand is caused by a fracture of the scaphoid bone, but these are often overlooked.
Typically, a scaphoid fracture is relatively difficult to make out on an X-ray, which is why it is CT has established itself as the diagnostic agent of choice.
If there is no treatment, there is a risk that the fracture fragments will grow onto one another in a misalignment. Since the eight carpal bones are in close physical relationship with one another, one occurs changed force effect in the wrist. You can imagine it as if one bridge pillar could suddenly bear less weight and distribute its load to the other bridge piers. As a result, the so-called "SNAC wrist syndrome"Come, freely translated from the English" collapse after failure of the scaphoid bone to heal "(Scaphoid Nonunion Advanced Collapse). This syndrome can turn into a Pseudoarthritis pass over.
In German one could best use the term "Pseudo-joint“Translate because the joint is still there, but not, or only limited works. A pseudarthrosis in the wrist area is problematic in that we use the hand every day for the simplest activities, and healing can only be achieved with surgery.
To do this, a piece of bone is removed from the iliac crest and inserted into the fractured navicular bone. Then a wire coming from the fingers is drilled in, which is used to estimate the length of the screw required. The individual bone fragments are threaded as centrally as possible on the screw, whereby an adequate blood supply must always be ensured. As the description of the operation suggests, it is a relatively tricky procedure.
However, it is relatively difficult to accelerate healing. The bone takes time to grow together and the blood vessels must first find their way to the fractured pieces of bone. In order to speed up the healing process, patients can take the greatest possible care and be patient. The scaphoid fracture is unfortunately one of the fractures that take a long time to heal. Even the best surgeon cannot change the anatomical conditions, so that at most one pain medication remains until the end of the therapy. For pain, the doctor usually prescribes commercially available pain relievers such as Ibuprofen, or Paracetamolthat are well tolerated by patients.
