A scaphoid fracture happens when one of the small bones in your wrist breaks due to trauma or injury. This type of injury is often seen in athletes, especially in contact sports, but can also occur in everyday accidents like falls.
While many scaphoid fractures can heal with non-surgical treatment, some cases may require scaphoid fracture surgery for a full recovery. This guide will walk you through what you need to know about scaphoid fracture surgery, including the following:
- Procedure
- Recovery
- Success rate
- Post-operative care
Keep reading to learn more.
What Is a Scaphoid Fracture?
Eight bones make up the wrist joint, and the scaphoid is one of the key ones. It is located between the forearm and the hand and plays a crucial role in wrist movement. It helps stabilize the wrist and supports the hand when gripping or lifting.
Due to its position, the scaphoid is essential for hand strength and flexibility. However, its limited blood supply can slow healing if it becomes injured.
A scaphoid fracture typically occurs when a person falls onto an outstretched hand, and the palm hits the ground forcefully. The force of the impact can cause the scaphoid to crack or break.
Variations in Scaphoid Fracture Types
Scaphoid fractures can occur in three distinct areas, each of which can affect the treatment approach.
Proximal scaphoid fractures occur at the end of the bone closest to the forearm. Because this area has a limited blood supply, these fractures are often more challenging to heal and may need surgery or bone grafting to promote recovery.
Waist Fractures (middle fractures) are the most common type of scaphoid fracture. These fractures are typically stable and may be treated with a cast if non-displaced. However, displaced fractures may need surgery to realign the bone and ensure proper healing.
Distal fractures occur closer to the thumb and typically have a better blood supply than proximal fractures.
Displaced vs. Non-Displaced Fractures
A displaced fracture means the bone has broken into two or more fragments, and the pieces are no longer properly aligned. These fractures typically require surgery, such as internal fixation, to realign the bone and ensure proper healing.
A non-displaced fracture means the bone has cracked but remains properly aligned. It is usually treated with a cast or splint to immobilize the wrist and allow the bone to heal naturally. Close follow-up is still needed to ensure stability.
Symptoms of a Scaphoid Fracture
Common symptoms of a scaphoid fracture include the following:
- Pain in the wrist, especially in the area around the base of the thumb
- Swelling and bruising around the wrist
- Limited range of motion in the wrist
- Tenderness when touching the scaphoid bone
If you experience these symptoms, it is important to seek medical attention, as early diagnosis and treatment can prevent complications.
Why Is Surgery Needed for a Scaphoid Fracture?
Not all scaphoid fractures require surgery. However, surgery may be necessary for fractures that are:
- Displaced, where the bone pieces are no longer aligned
- Unstable, where the fracture is unlikely to heal on its own or has a higher risk of nonunion
- Complex, where the fracture involves multiple breaks or the bone is shattered
A doctor will determine whether surgery is required based on the severity of the fracture, the patient’s health, and how well the bone is healing.
Types of Scaphoid Fracture Surgery
Doctors can perform several types of procedures to treat scaphoid fractures. Here’s what they may use.
Internal Fixation Surgery
Internal fixation is the most common procedure for scaphoid fractures. This technique provides stability to the bone and encourages healing. The options for internal fixation include:
- Screws inserted into the bone to hold the fracture in place to align the bone and support the healing process
- Pins used for smaller fractures or when the surgeon wants to minimize the incision size
- Wires used temporarily for fractures that are difficult to stabilize, keeping the bone pieces aligned
Bone Grafting Surgery
In cases where a large part of the scaphoid bone is missing or has become damaged, bone grafting may be necessary. During this procedure, a piece of bone from another part of the body (often the hip or wrist) is used to fill in the gap. This helps promote healing by stimulating bone growth.
Open Reduction
Open reduction may be required for complex or severely displaced fractures. This is a more involved procedure where the surgeon makes an incision to reach the broken bone. After repositioning the bone fragments, the surgeon will secure them with screws or plates to hold them together.
What to Expect During Scaphoid Fracture Surgery
Scaphoid fracture surgery is typically performed under local or general anesthesia, depending on the complexity of the surgery and the patient’s preference. Here’s a brief look at what to expect throughout the process.
Pre-Surgery Consultation
Before the surgery, your doctor will discuss your medical history, perform any necessary tests (such as X-rays or CT scans), and discuss the surgical options. This consultation is essential for ensuring the right approach, and it’s also a good time for patients to ask questions about the following:
- The procedure
- Recovery process
- Potential risks
Be ready to discuss any medications you’re taking, including over-the-counter drugs or any supplements, as they can impact the surgery.
Surgical Procedure
The surgery typically lasts one to two hours. A small incision is made, and the surgeon realigns the bone fragments using internal fixation methods like screws or pins to ensure proper healing.
If the fracture is more complex, additional fixation with plates or other methods may be required.
After the surgery, you are monitored in a recovery room until the anesthesia wears off. Depending on the type of surgery, you may need to stay in the hospital for a day or two for further observation and care.
Scaphoid Fracture Recovery
Recovery after scaphoid fracture surgery can take several months, and following your doctor’s advice is essential to ensure proper healing.
Factors such as the fracture type, the surgery performed, and your overall health will affect your recovery timeline. The details below will give you a clearer picture of what to expect during this period.
Initial Recovery (First Few Weeks)
In the first few weeks after surgery, you will be required to keep your wrist immobilized. This is typically done with a cast or a splint to hold the bone properly while it starts to heal.
Your doctor will prescribe pain medication during this time to help manage discomfort. Here are a key things to keep in mind during this stage of recovery:
- Do not lift heavy objects or take part in activities that could strain your wrist
- You must return to the doctor for follow-up appointments to monitor the healing process
- Always keep the cast or splint clean and dry, and follow all instructions if you have surgical dressings
Physical Therapy and Rehabilitation
Physical therapy may be recommended once the bone starts healing to restore your wrist’s strength, mobility, and function. Therapy may include the following options.
Range of motion exercises to help restore flexibility and movement in the wrist and hand. It can include:
- Gentle wrist circles
- Wrist flexion and extension stretches
- Use of therapy putty to improve finger and wrist coordination
Strengthening exercises will slowly be introduced to rebuild muscle strength and stability. Examples include:
- Using a soft ball for grip strengthening
- Wrist curls using resistance bands or light weights
- Radial/ulnar deviation movements with a small dumbbell
Functional training with activities that simulate daily tasks to help you return to work, sports, or hobbies. This may cover:
- Practicing buttoning a shirt
- Typing
- Lifting light objects
- Swinging a golf club (in later stages of recovery)
Your physical therapist will tailor your rehabilitation program to your needs, helping you safely return to normal activities.
Scaphoid Surgery Success Rate
Scaphoid fracture surgery is generally successful, with high healing rates when performed correctly. Success rates may depend on the following:
- The severity of the fracture
- The type of surgery
- How the patient follows post-operative care instructions
However, complications such as nonunion, infection, or stiffness can occur. Contact your doctor if you experience unusual symptoms such as persistent pain, swelling, or difficulty moving your wrist after surgery.
Post-Operative Care for Scaphoid Fracture Surgery
Good post-operative care is crucial to ensure a successful recovery from scaphoid fracture surgery. The following guidelines can support your healing process.
Rest and Elevation
After surgery, keep your wrist elevated to reduce swelling. Avoid moving or using the wrist too much during the initial healing phase.
Pain Management
Your doctor will prescribe pain medication as needed to manage discomfort. It is essential to follow their instructions for taking medication to avoid complications.
Wound Care
Keep the surgical site clean and dry. Follow your doctor’s instructions for changing dressings and caring for the wound.
Gradual Return to Activities
Once your doctor has cleared you, you can gradually return to daily activities. However, avoid the following until you have fully healed:
- Lifting heavy objects that could put stress on the wrist and disrupt the healing process
- Engaging in sports or high-risk activities until your doctor gives the go-ahead
- Using the hand for activities that involve repetitive motions or strain on the wrist, such as typing, writing, or any action that places weight or pressure on the healing bone
Following these restrictions during recovery is crucial for promoting healing and avoiding setbacks. Always check with your healthcare provider for any specific guidelines based on your surgery and recovery progress.
Scaphoid Healing Process
The scaphoid healing process is unique because, as mentioned, the scaphoid bone has a limited blood supply. This can result in more extended healing periods compared to other bones.
Healing times vary, but typically, it takes around 6-12 weeks for the bone to start healing and up to 6 months for full recovery. Avoid putting stress on the wrist to ensure proper healing during this time.
Your doctor may use X-rays or other imaging techniques to track your healing progress.
Complications and Risks of Scaphoid Fracture Surgery
While scaphoid fracture surgery is usually considered safe and effective, it carries possible risks and complications that patients should understand.
Nonunion
Nonunion occurs when the fractured bone fails to heal completely. It can lead to ongoing pain and reduced wrist function and may require extra procedures such as bone grafting or revision surgery.
Infection
Although uncommon, post-surgical infections can develop at the incision site or deeper within the wrist. Proper wound care and following the surgeon’s instructions can reduce this risk. In more serious cases, antibiotics or further surgery may be needed.
Stiffness and Reduced Mobility
Some patients may experience stiffness, reduced range of motion, or weakness in the wrist after healing. A structured physical therapy program often improves mobility, but some patients may never regain their full pre-injury range.
Nerve or Blood Vessel Damage
During surgery, there is a small risk of accidental injury to nearby nerves or blood vessels. It can cause numbness, tingling, or circulatory issues, which can be temporary. However, in rare cases, it may be permanent.
Hardware Complications
Pins or screws used to stabilize the bone may cause irritation or become loose over time. In some cases, Doctors may perform a separate procedure to remove the hardware.
Avascular Necrosis (AVN)
A fracture can disrupt the scaphoid blood supply. In some cases, this leads to AVN, where part of the bone dies because of reduced blood flow. It can cause long-term wrist problems and may require further treatment.
What to Know About Scaphoid Fracture Surgery
Scaphoid fracture surgery is effective for severe, displaced, or unstable fractures. The procedure is generally safe, with most patients recovering fully after rehabilitation. Following post-operative care and working closely with your healthcare team is key to a positive outcome.
Trust the Hand Surgery Specialists of Texas for expert care in scaphoid fractures and other wrist injuries. Our fellowship-trained, board-certified surgeons use advanced, minimally invasive techniques to promote faster healing and reduce downtime.
With locations across Houston and compassionate, patient-centered care, we’re here to help you return to what you love; contact us today.
