What is scaphoid nonunion?

Scaphoid fractures are relatively common and typically occur after a falling onto an outstretched hand. Because the scaphoid bone is mostly covered in cartilage and has a poor blood supply, fractures need a good blood supply in order to heal properly. When some bone fragments do not receive an adequate blood supply due to the trauma of the fracture, the fracture can fail to heal - and this is known as a scaphoid nonunion.

What causes scaphoid nonunion?

Scaphoid nonunions follow scaphoid fractures that are usually the result of falls on an outstretched hand. This can happen during sports like football, rugby, skiing or snowboarding. It is understood that patients with pre-existing medical conditions, or who smoke, have more chance of developing a scaphoid nonunion because of their compromised ability to heal.

Symptoms of scaphoid nonunion

The predominant symptom of scaphoid nonunion is pain which fails to subside in the normal way following a fall and fracture. Most patients will have fallen onto an outstretched hand and exhibit the typical symptoms of the fall; including swelling and pain around the thumb's base and the wrist.

There may also be symptoms associated with wrist arthritis, and patients may have suffered a minor trauma or sprain of the wrist which has reoccurred.

Treatment options for scaphoid nonunion

The treatment advised for an acute scaphoid fracture generally depends on the fracture's position and the location of the bone fragments which have fractured. Wearing a below elbow plaster and hand therapy can be suitable treatments for straightforward fractures which are not displaced, while minimally displaced fractures can require a small operation that involves an incision at the back of the wrist and the placement of a screw to compress fragments together. More complex fractures can require open surgery in order to realign fragments before stabilisation with a screw.

Scaphoid nonunions themselves can be complex to treat, but if they are left untreated, there is a risk of wrist arthritis. Open surgery is typically required for a scaphoid nonunion, with a bone graft being taken from an area such as the radius bone in the forearm, or the pelvis, and placed in the bone gap which is caused by the nonunion. After that, a screw is used to compress the bone graft and scaphoid which helps to stimulate the healing of the scaphoid fracture.

In general, most patients will recover from surgery for scaphoid nonunion in around six to eight weeks following plaster cast immobilisation. You can expect some stiffness for up to six months following the procedure, and hand therapy will help to alleviate this inflexibility. Some patients could experience discomfort around the area where the bone graft has been taken from. This typically subsides over time.

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