What is Scaphoid fracture fixation?

 

Scaphoid fracture fixation refers to the surgical or non-surgical treatment used to stabilize and heal a fracture of the scaphoid bone in the wrist. The scaphoid is one of the small carpal bones in the wrist, located on the thumb side, and plays a crucial role in wrist movement and stability. Here's a detailed explanation:

Scaphoid Fracture:

  1. Location: The scaphoid bone is situated in the proximal row of the carpal bones, near the base of the thumb. It spans the two rows of carpal bones, contributing to wrist stability.
  2. Causes: Scaphoid fractures commonly result from a fall onto an outstretched hand, sports injuries, or direct trauma to the wrist.
  3. Symptoms:
  • Pain and tenderness in the anatomical snuffbox (the area between the thumb and the wrist)
  • Swelling and bruising around the wrist
  • Difficulty gripping or pinching objects
  • Limited range of motion in the wrist

Diagnosis:

  • Physical Examination: Includes checking for tenderness in the anatomical snuffbox and assessing wrist movement.
  • Imaging Studies: X-rays, CT scans, or MRI are used to confirm the diagnosis and assess the fracture's location and severity.
    • Casting: If the fracture is non-displaced (bone fragments are aligned), a cast or splint may be used to immobilize the wrist and allow the bone to heal naturally. The cast typically covers the thumb and extends past the wrist to limit movement.
    • Duration: Immobilization usually lasts for 6-12 weeks, depending on the fracture's severity and healing progress.

Treatment Options:

Non-surgical Treatment:

  1. Immobilization:

Surgical Treatment (Scaphoid Fracture Fixation):

  1. Indications for Surgery:
  • Displaced fractures (bone fragments are not aligned)
  • Fractures that do not heal with non-surgical treatment (non-union)
  • Fractures with a high risk of poor healing due to poor blood supply to the scaphoid
  • Open Reduction Internal Fixation (ORIF): Involves making an incision to expose the fracture site. The bone fragments are realigned (reduced) and stabilized using internal fixation devices such as screws or wires.
  • Percutaneous Fixation: A less invasive technique where screws or wires are inserted through small incisions without fully exposing the fracture site. This approach minimizes tissue disruption and may reduce recovery time.
  • Screws: Specially designed screws are used to hold the bone fragments together, providing stability and promoting proper healing. Herbert screws or headless compression screws are commonly used for scaphoid fractures.
  1. Surgical Procedure:
  2. Internal Fixation Devices:

Rehabilitation:

  1. Post-operative Care:
  • Immobilization: After surgery, the wrist may be immobilized in a cast or splint for a few weeks to protect the repair and allow initial healing.
  • Wound Care: Proper care of the surgical incision to prevent infection.
  • Range of Motion Exercises: To restore movement in the wrist and thumb.
  • Strengthening Exercises: To rebuild strength in the wrist and hand.
  • Duration: Rehabilitation can take several months, depending on the severity of the fracture and the patient's adherence to therapy.
  1. Physical Therapy:

Advantages of Surgical Fixation:

  1. Stable Fixation: Internal fixation provides stable alignment of bone fragments, promoting faster and more reliable healing.
  2. Early Mobilization: Patients may begin gentle wrist movements sooner compared to prolonged casting, reducing the risk of stiffness.
  3. Reduced Risk of Non-union: Surgical fixation can help prevent complications such as non-union or malunion (improper healing).

Disadvantages and Risks:

  1. Surgical Risks: Includes risks such as infection, bleeding, nerve or blood vessel damage, and complications related to anesthesia.
  2. Hardware Complications: There is a possibility of irritation or discomfort from the internal fixation devices, and in some cases, hardware may need to be removed later.
  3. Recovery Time: Although surgical fixation may allow for earlier movement, overall recovery can still be lengthy, requiring commitment to rehabilitation.

Summary:

Scaphoid fracture fixation refers to the treatment methods used to stabilize and heal a fracture of the scaphoid bone in the wrist. Treatment can be non-surgical, involving immobilization with a cast, or surgical, involving internal fixation with screws or wires. Surgical fixation is often indicated for displaced fractures or those at risk of poor healing. Proper rehabilitation is essential for restoring wrist function and strength.

Disclaimer:

Patients considering scaphoid fracture fixation should consult with their orthopedic surgeon to discuss their specific condition, treatment options, potential benefits, and risks associated with the procedure. This summary provides general information and should not substitute personalized medical advice from a qualified healthcare professional.

 

 

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