Scaphoid Fractures: Why Early Surgery Can Prevent Complications
By Dr. Oren Michaeli, DO – Board Certified General Surgeon, Fellowship-Trained in Hand Surgery, Microsurgery, and Peripheral Nerve Surgery
Introduction
The scaphoid bone, located at the base of the thumb, plays a critical role in wrist motion and stability. Unfortunately, its location and limited blood supply make it particularly vulnerable to fractures that are challenging to heal. Scaphoid fractures often occur from falls onto an outstretched hand, and without timely and effective treatment, they can lead to nonunion (failure to heal), long-term wrist pain, stiffness, and arthritis.
At Hand, Nerve & Microsurgery PC, I recommend treating most scaphoid fractures with a minimally invasive surgical approach. This proactive strategy involves placing a small compression screw through a tiny incision to stabilize the bone, minimizing the risk of complications and ensuring a smoother recovery.
What Is a Scaphoid Fracture?
The scaphoid is a small, boat-shaped bone in the wrist, sitting between the radius and the base of the thumb. Its unique shape and location make it prone to fractures, particularly in the middle (waist) of the bone. The vascularity of the scaphoid is limited, especially in its proximal pole, which complicates its ability to heal without proper stabilization.
This is a drawing of the scaphoid. You need blood to heal so if you cut off the blood supply the bone may never fuse.
Symptoms of a Scaphoid Fracture:
Pain in the Wrist or Thumb: Often worsened by gripping or moving the wrist.
Tenderness in the Snuffbox: The area at the base of the thumb near the wrist may be tender to touch.
Swelling: Localized swelling near the thumb side of the wrist.
Difficulty with Wrist Motion: Activities requiring wrist flexibility, like turning a doorknob, may be painful.
The Challenge of Non-Operative Treatment
For many types of fractures, non-operative treatment such as casting is an appropriate first step. However, with scaphoid fractures, this approach carries greater risks due to the bone's poor blood supply, particularly in the proximal portion. Without surgical stabilization, scaphoid fractures are prone to:
Nonunion: When the bone fails to heal, it can lead to chronic pain, instability, and eventual arthritis.
Delayed Healing: Even in cases where healing is possible, prolonged immobilization can cause stiffness and reduced wrist motion.
Future Surgeries: Nonunion often requires more complex surgical procedures, such as bone grafting, sometimes involving harvesting bone from the hip.
Why Surgery Is the Preferred Option
At Hand, Nerve & Microsurgery PC, I recommend treating most scaphoid fractures with minimally invasive surgical fixation using a percutaneous compression screw. This approach offers several advantages over non-operative management:
Minimally Invasive Procedure:
The surgery involves a tiny 2-3mm incision, often closed with glue rather than stitches, leaving virtually no visible scar.
The screw is placed through the fracture to stabilize the bone and promote healing.
Short Recovery Time:
Unlike prolonged casting, surgical fixation allows for earlier wrist motion and faster return to normal activities.
Prevents Nonunion:
By stabilizing the fracture immediately, the surgery greatly reduces the risk of complications such as nonunion or delayed healing.
Avoids Future Complex Surgeries:
A small, minimally invasive procedure now can prevent the need for extensive surgeries later, such as bone grafting from the hip or reconstructive procedures.
When Surgery Is Recommended
Surgical treatment is especially beneficial for the following cases:
Displaced Scaphoid Fractures: Bone fragments that are not aligned require stabilization to heal properly.
Fractures at Risk of Nonunion: Fractures in the proximal pole or waist of the scaphoid are particularly prone to poor healing.
Patients Who Need Early Recovery: Athletes, manual laborers, or others requiring fast recovery of wrist function often benefit from surgical treatment.
When Non-Operative Treatment May Be an Option
While surgery is highly recommended for most scaphoid fractures, non-operative treatment may still be appropriate for patients who are:
Unwilling to Undergo Surgery: Patients who decline surgery can be managed with rigid casting for 8–12 weeks, though they must understand the increased risk of nonunion and potential need for future surgery.
Medically Unfit for Surgery: Patients with conditions that make surgery unsafe may require casting, despite the challenges associated with this approach.
The Procedure: Percutaneous Compression Screw Fixation
The procedure is straightforward and minimally invasive:
Incision: A 3mm incision is made near the fracture site.
Screw Placement: Using X-ray guidance, a specialized compression screw is inserted through the scaphoid to stabilize the fracture.
Closure: The incision is closed with surgical glue, eliminating the need for sutures.
The entire procedure typically takes less than an hour and is performed under regional or general anesthesia.
Recovery and Rehabilitation
Most patients experience a faster recovery with surgery compared to casting:
Immobilization: A splint or soft cast may be worn for a short period after surgery.
Physical Therapy: Gradual exercises to restore wrist motion and strength are started earlier than with non-operative treatment.
Timeline: Healing typically occurs within 6–8 weeks, though individual recovery times may vary.
Benefits of Early Surgical Intervention
Minimizes Complications: Reduces the risk of nonunion or delayed healing.
Improved Function: Allows for earlier motion, minimizing stiffness and preserving wrist function.
Cosmetic Advantage: The small incision leaves minimal scarring, often indistinguishable after healing.
Long-Term Success: Prevents the need for complex and invasive procedures like bone grafting.
Why Choose Dr. Oren Michaeli at Hand, Nerve & Microsurgery PC?
Expertise in Scaphoid Fractures: With extensive experience in wrist surgeries, I specialize in minimally invasive techniques to optimize healing and recovery.
Patient-Centered Care: I tailor treatment plans to each individual, prioritizing their unique needs and goals.
State-of-the-Art Technology: From percutaneous fixation to advanced imaging, I utilize the latest tools to ensure precise and effective results.
Scheduling a Consultation
If you’ve suffered a scaphoid fracture or suspect a wrist injury, don’t delay seeking treatment. Early intervention can prevent complications and ensure a faster recovery.
Phone: (212) 540-4263
Email: Info@handnervemicrosurgery.com
Office: 570 Sylvan Ave, 2nd Floor, Englewood Cliffs, NJ 07632
