Problem
- The scaphoid bone has failed to heal. This causes ongoing pain and eventually leads to wrist arthritis
Cause
- The scaphoid has a tenuous, retrograde blood supply and is surrounded by synovial fluid. This makes it one of the most common bones to develop a nonunion.
Diagnosis
- Pain in the ‘snuff box’
- Weakness of grip strength
- Decreased wrist movement
- X-rays usually confirm the diagnosis
- CT scan to look for a ‘humpback’ deformity
- MRI scan to assess blood supply to the bone
Treatment
- Surgery – GA – Day surgery or Overnight Stay
Incision on back of wrist, or front of wrist
Debridement of nonunion site
Packing with bone graft (from distal radius)
Humpback deformities require structured graft from the hip
Fixation with cannulated screw
Potential Complications
- Infection, haematoma, nerve injury
- Stiffness in wrist.
- Non Union or malunion.
Post Op Care
- Cast for 8 weeks or until bone healed.
- Hand therapy once out of plaster.
- Unable to use hand for heavy lifting until bone healed.
