Scaphoid fractures are common wrist injuries, often resulting from a fall onto an outstretched hand. The scaphoid bone, located near the base of the thumb, plays a crucial role in wrist stability and movement. Fractures can lead to significant discomfort and impaired range of motion, often causing persistent wrist pain.
At UK Hand & Wrist Surgery, we specialise in precise surgical treatment for scaphoid fractures, led by Mr Patrick Goon, a Specialist Hand and Wrist Surgeon committed to helping patients regain full wrist function and alleviate pain through advanced techniques.
What is a Scaphoid Fracture?
A scaphoid fracture typically occurs when one falls onto an outstretched hand, exerting force on the scaphoid bone. Due to its unique location and blood vascularity, the scaphoid bone is vulnerable to fractures, and more specifically, prone to non-healing if untreated, particularly across the proximal pole, where blood supply is more limited.
Injuries to the proximal pole of this bone can disrupt blood flow, potentially delaying or negating bone healing and increasing the risk of complications such as avascular necrosis – a condition where bone tissue dies due to insufficient blood supply.
Symptoms of a Scaphoid Fracture
Scaphoid fractures can present with various symptoms, often depending on the fracture location and severity. Recognising these symptoms promptly is essential, as undiagnosed fractures can progress and complicate recovery:
- Persistent wrist pain, especially in the anatomical snuffbox (a small depression near the base of the thumb)
- Swelling and tenderness around the base of the thumb and wrist
- Limited range of motion, especially when gripping or rotating the wrist
- Pain exacerbated by movements that involve pressure on the wrist, for example pushing off an arm rest or chair.
In some cases, patients may experience what are known as occult fractures, where symptoms are mild and the fracture may not appear on initial imaging. If a scaphoid fracture is suspected, advanced diagnostic tools are often recommended to confirm the injury.
Scaphoid fracture surgery is often recommended for fractures with poor blood supply, promoting effective healing and preventing complications.
Scaphoid Fracture Treatment
Treatment for scaphoid fractures varies based on factors such as fracture location, blood flow and the fracture’s stability. For fractures that are stable and well-aligned, non-surgical methods may suffice. However, many scaphoid fractures require surgical treatment to promote effective healing and prevent long-term complications of pain, stiffness, weakness and arthritis.
Non-Surgical Treatment
In cases where the fracture is minor or stable, immobilisation in a cast can support fracture healing. In some instances, a bone stimulator may also be recommended to enhance bone healing and ensure stability.
Internal Fixation
This approach uses screws, pins or plates to secure the fractured bone segments. For fractures affecting the proximal pole, internal fixation is particularly important as it promotes stability in an area with limited blood supply, reducing the risk of non-union. New onset fractures can normally be fixed using percutaneous techniques, without the need for open surgery.
Bone Graft Surgery
If bone loss is present, or risk of non-union is significant, a bone graft may be recommended to stimulate healing. This procedure involves transplanting healthy bone tissue to the fracture site, encouraging bone growth and aiding in healing. This is usually not necessary in the acute phase of treating a new fracture. In established cases of non-union (usually more than 6 months since event of injury), using bone graft is recommended to improve the success rate of surgery.
Arthroscopic Fixation
In some cases, chronic non-union surgery involving bone grafting may be suitably performed with a minimally invasive approach using arthroscopy. The access skin incisions or ports are very small, and the fracture surfaces are prepared and grafted arthroscopically, under direct vision using a tiny video camera scope. This technique involves a highly technical and challenging surgery, and requires expertise to perform. The benefits are less scarring and a shorter recovery period.
Microsurgical Bone Flap Surgery
Sometimes when a case of scaphoid fracture non-union is deemed to be at especially high risk of further non-union even with conventional bone grafting, then we would recommend a microvascular or microsurgical procedure, to transport a bone block with its own blood-supplying vessels, in order to fix the scaphoid and maximise chances of bone healing. Donor sites range from the knee area to the coracoid bone near the clavicle or collar bone and are chosen for their low morbidity and minimal lifestyle impact. The procedure is highly complex, usually performed with 2 Consultants, and takes between 4 and 6 hours, requiring microsurgery with a microscope. Patients normally undergo a general anaesthetic, and have an overnight stay.
Scaphoid fracture surgery involves advanced techniques to ensure precise stabilisation and encourage natural bone healing.
Benefits of Scaphoid Fracture Surgery
Scaphoid fracture surgery aims to stabilise the wrist, restore range of motion and prevent further complications. Surgery provides several key benefits:
- Enhanced fracture healing and support for fractures prone to nonunion
- Restoration of wrist stability and strength
- Reduced pain, enabling daily tasks and activities
- Prevention of complications, such as scaphoid nonunion advanced collapse (SNAC), which can lead to severe wrist dysfunction due to progressive arthritis, if left untreated.
With proper treatment, most patients experience improved wrist function and a reduction in pain, allowing them to return to daily activities with fewer limitations.
Recovery and Aftercare
Post-surgical recovery for scaphoid fractures requires a period of rest and rehabilitation to ensure optimal healing. The timeline for recovery depends on the fracture location and the specific treatment approach.
- Immobilisation: Following surgery, the wrist may be placed in a cast or splint to restrict movement and protect the scaphoid during the initial healing phase.
- Physical Therapy: Once healing has progressed, physical therapy can help improve the range of motion and restore strength to the wrist.
- Follow-Up Appointments: Regular follow-ups will monitor progress and address any concerns during recovery.
Mr Goon will provide personalised recovery guidance, including exercises and tips to support long-term wrist health.
Why Choose UK Hand & Wrist Surgery
for Scaphoid Fracture Treatment?
UK Hand & Wrist Surgery is committed to providing specialised care for scaphoid fractures, focusing on advanced and proven techniques to address the unique challenges posed by this common carpal bone fracture. Led by Mr Patrick Goon, our team offers tailored treatment for each case, prioritising effective fracture healing and restoring function to the wrist. The ability to incorporate the option of using microvascular surgery or arthroscopy to maximise the chances of fracture healing in specific cases is an important example of technical versatility and expertise offered. Patients can be confident that their surgeon will fully inform them of all options, and help them find the most suitable solution, rather than a scenario of a surgeon offering limited surgical options due to their limited expertise.
Whether dealing with recent injuries or complex proximal pole fractures, UK Hand & Wrist Surgery provides comprehensive support for each patient’s recovery journey, aiming to improve wrist function and quality of life.
Meet Mr Patrick Goon
Mr Goon, a highly trained Specialist Hand Surgeon, leads our clinic with expertise and a commitment to excellence in care. His experience spans a range of simple to complex procedures, from carpal tunnel release to wrist joint replacements and tendon repair. His focus on minimally invasive techniques supports optimal recovery and reduces post-operative discomfort, ensuring patients achieve the best possible outcomes.
Find out more
Book an Appointment with Mr Goon
If you are suffering from a hand or wrist problem, please use the online form to contact us and arrange an appointment with Mr Goon. Alternatively, you can call us on 01707 443 444 or email us at Enquiries@hertfordshirehandsurgery.com
Frequently Asked Questions
What part of the wrist is most affected by scaphoid fractures?
The scaphoid is one of the carpal bones in the wrist, positioned near the base of the thumb. Due to its unique blood supply, fractures here, especially in the proximal area, can lead to complications if not treated promptly.
What is the role of the distal pole in scaphoid fractures?
The distal pole of the scaphoid bone is the section closest to the thumb. Fractures in this area tend to heal more easily due to better blood supply, unlike those in the proximal pole, the section closest to the wrist, which may require more intensive treatment.
Why is early treatment essential for scaphoid fractures?
Prompt treatment of scaphoid fractures is crucial to avoid complications like nonunion and avascular necrosis, where limited blood flow can impair bone healing and lead to long-term wrist issues like chronic pain, stiffness, limited strength and progressive arthritis.
How does blood supply affect healing in scaphoid fractures?
The scaphoid has both a volar and a dorsal blood supply, with the majority supplied dorsally. However, blood flow is limited in certain areas, especially the proximal pole, making some fractures more challenging to heal.
Are scaphoid fractures considered acute wrist injuries?
Yes, scaphoid fractures are classified as acute wrist injuries, typically resulting from a fall or direct impact to the wrist. Early diagnosis and treatment are key to preventing complications.
What Our Patients Say
Written by a NHS patient at Lister Hospital
5th July 2024
I managed to dislocate one knuckle and badly break another knuckle in the same finger into multiple pieces, an injury which every Healthcare Professional that saw the X-ray told me was not only severe damage but also a particularly rare injury. Mr Goon and his team screwed the knuckle back together, which was particularly fiddly given the multiple small pieces.
After the operation I was given a number of exercises which were progressively added to over a series of regular appointments, both with Mr Goon and multiple Hand Therapists, to check and monitor my progress. I followed their instructions as closely as I could, both in frequency of exercising and how far to push the injury (I did want to actually recover fully after all, so why would I have not listened to the experts!), even though this was sometimes inconvenient or sore.
I’m delighted to say that I now have full use and movement of the finger and a scar which is unnoticeable unless you look very closely for it. Mr Goon and his team are all a credit to the NHS, not only due to their expertise, but all kept a very friendly and positive attitude at all times not just about the potential recovery but also with their general demeanor, were always supportive and happy to answer any question I had, even if I was worried they may have been obvious answers, and were always clear about the next steps I needed to take.
It’s also worth mentioning for anyone that may be critical of the NHS which is clearly currently under intense pressure based on the number of patients in the Hospital ever time I went in, I sustained the injury on a Wednesday evening, had the dislocation sorted at a Hospital walk-in clinic within 1.5 hours and had met the surgeon, gone through the options and procedure and was in surgery by Saturday morning. Mr Goon even came to see me himself and tell me how the procedure had gone as soon as I was fully awake. This shows what an amazing service the NHS actually provides, and I didn’t have to pay a penny.
The whole experience has far exceeded my expectations and I can only thank Mr Goon and his entire team for the amazing work that they have done to ensure my full recovery.
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Written by a NHS patient at Lister Hospital
3rd October 2024
I had an accident at work that led to part of my finger being cut off. Mr. Goon has been treating me, and thanks to his skill, I’ve actually got that part of my finger back, including the nail. Honestly didn’t think that’d be possible, especially not so soon. I’m really grateful to have had such a great doctor during such a rough time. It couldn’t have gone better. Joe Efford
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Written by a NHS patient at Lister Hospital
10th October 2024
I saw Dr Goon following an accident with a horse which resulted in numerous breakages in my thumb. Having had numerous visits and having experienced terrible pain I was not sure if Doctor Goon could help. How wrong I was, he was extremely good in every aspect of his work getting my pain under control pretty quickly. He reassured me, listening to my concerns and always made me feel completely at ease. He has a very positive attitude at all times with every visit exceeding my expectations. I will require further surgery but I am not concerned as I cannot fault the care from Mr Goon and his great team to date. I know I will be in safe hands. He is indeed “The Miracle Man”.
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