Scaphoid fracture management

[bignumber]

Hi,

I fractured my scaphoid a few years ago. It was missed in the first x-ray then two weeks later put in a cast. It was in  a cast for a total of six weeks then a soft removable splint was recommended for  four weeks. Below is a review of the x-rays. I am wondering, based on the x-ray reviews, if it was appropriate that the cast was removed on 30/10/09 and treated with a splint, or was my scaphoid doomed to progress to non-union irrespective of treatment.

5/09/09 - An AP and lateral of the left wrist show a fracture of the waist of the the left scaphoid. There is no displacement.
16/10/09 - X-rays of the left scaphoid show a fracture of the waist of the scaphoid with slight displacement. There is no evidence of a dorsal intercalated segment instability (DISI deformity).
30/10/09 The fracture of the waist of the scaphoid is still evident with suggestion of cystic change. There is an early DISI deformity.
12/02/10 There is non-union of the left scaphoid with cystic change and a DISI deformity.

Thanks
Martin

[bignumber]

Hi Dr Kaul,

Thanks for the reply! The information was indeed helpful.
I believed though that if there were little chance of union after 6 weeks of failed conservative treatment, surgical fixation would be the next option, before it could degenerate further. Was I wrong in that assumption?

Thanks again,
Martin

[S. Kaul, MD]

Hey Martin!

Non-union and necrosis are common complications of fracture scaphoid. When the cast was removed, I assume it was already 6 weeks into the injury and there are little chances of union post that period. Keeping the cast would not have made a major difference to the fracture but would have made the muscle stiff. Replacing with a splint was an acceptable option.
Hope this information is helpful.

Take care!