Question:I had a drill press at work slip and hit my wrist dead center. Broke the middle bone (scaphoid) into three pieces. The wrist never healed properly. Looks like surgery is next. What can they really do for this problem?
Answer:The scaphoid is a key player in wrist movement because of its location. It sits in the center of the wrist. Any trauma, injury, or other disease process that affects the scaphoid can also potentially affect the other bones and ligaments in contact with the scaphoid. Damage (tears or ruptures) of the scapholunate ligament (between the scaphoid and lunate bones) puts the wrist at risk for uneven wear, joint degeneration, and wrist arthritis. Fractures of the scaphoid bone that don't heal (called a nonunion fracture) can result in the same process of joint destruction and arthritis. Treatment may depend on what's happening with the scaphoid. For example, has it collapsed and shifted out of alignment? Is the scapholunate ligament torn or ruptured? What other bones are affected? And finally, has the scaphoid fracture healed or is there a nonunion fracture still present? The least invasive (nonoperative) method can be tried first. (splint, hand therapy). Medications may be added if pain is a problem. If you don't improve or only have limited change in your pain, then injection therapy or nerve denervaton (sensory nerve sending pain messages is destroyed) can be tried. Surgery is the last option when pain and weakness and loss of function persist or progress. Surgery can also be done in stages. Removal of the damaged scaphoid and a fusion of the remaining bones surrounding the (now missing) scaphoid allow for some wrist motion to be saved. Alternately, the affected row of carpal Robert J. Strauch, MD. Scapholunate Advanced Collapse and Scaphoid Nonunion Advanced Collapse Arthritis -- Update on Evaluation and Treatment. In The Journal of Hand Surgery. April 2011.
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