The Scaphoid bone has a funny name, because it derives it from the Greek word Scaphoides. This means boat shaped, corresponding to the shape of the bone. The function of this boat-shaped bone is to couple the motion of several other bones in the wrist. The reason, that this bone gets so much attention is because of its healing properties. It is the most commonly broken bone in the wrist. It also has the worst blood supply. The reason is that the blood flow happens in a reversed fashion (front to back). That property makes it heal the worst out of any bone in the wrist.
When I hear of someone having a scaphoid fracture, I automatically ask six questions.
- How old is the patient?
- Does the patient smoke?
- How long ago did the break happen?
- What does the patient do for a living?
- Which area of the bone is broken?
- What is the pattern of the break?
My treatment plan varies with the answers to those questions. There are several constant Dr. Yevgeny rules that apply.
Younger patients heal faster and better. Smoking significantly decreases healing. Delay to treatment increases the likelihood that the break does not heal. The activity of the patient and their life and occupational goals affect my method of treatment. The closest to the arm part of the bone heals the worst. The farthest part of the bone heals the best. Patterns that are simple with the fragments unmoved heal the best.
Although casting is a valid method of treatment of scaphoid fractures, most hand surgeons are moving away from it. The reasons are:
- It takes a minimum of 3 months to heal a Scaphoid bone in a cast with perfect conditions.
- Complications of cast immobilization mean stiffness and multiple months of aggressive therapy to the elbow, forearm and wrist.
- The patients HATE the cast. Its like an itch you cannot scratch for 3 months.
- Even with the best efforts, healing does not always occur. In that case, the procedure that is required is far more extensive. Afterwards, therapy still has to happen.
- People want to get back to their usual life activities as soon as possible.
- People need to get back to work as soon as possible.
One method to fix a broken scaphoid is to put a screw inside the bone and compress it. After that, the patient starts very light motion immediately and progressively increases activity until the bone heals at 3 months. There is not cast. There is no stiffness and the patient goes back to normal activities then. The images show a wire going though the bone. A screw gets introduced over that wire and the bone break is compressed. The boat shape is restored.