When a Wrist Fracture Doesn't Heal RightIn this article Dr. Trumble, Chief Hand Surgeon from the University of Washington Medical Center in Seattle, reviews nonhealing fractures of the scaphoid bone. The scaphoid is a small bone in the wrist between the forearm and thumb. It's broken most often when someone falls with the hand stretched out and the wrist tilted slightly towards the ring finger. When a bone doesn't heal properly, it's called a nonunion fracture.
X-rays don't always show the fracture. Problems can occur if the scaphoid fracture isn't treated properly right away. Today, MRIs and CT scans help doctors see the fracture early on, so they can plan treatment. Sometimes casting the arm is all that's needed. Surgery may be required if the bone is broken into pieces or moved out of position.
Dr. Trumble and his associates review the anatomy and blood supply of the scaphoid in detail. They tell other doctors what to look for during the exam and on X-ray and how to avoid a nonunion fracture at this site. A scaphoid fracture can stop the blood flow to the bone. A special graft to replace the bone with bone that has a good blood supply may be needed.
Other surgical options are also discussed. Ways to do each operation are shown with detailed pictures. The wrist is a very complex area, and deformities can occur after injury. Dr. Trumble reviews how to use screws and wires to hold the wrist together. If the wrist fracture still doesn't heal, the wrist may collapse. The scaphoid may have to be taken out and the wrist fused. This is called a salvage operation.
Thomas E. Trumble, MD, et al. Management of Scaphoid Nonunions. In Journal of the American Academy of Orthopaedic Surgeons. November/December 2003. Vol. 11. No. 6. Pp. 380-391.
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