Therapy
Like all fractures, the scaphoid fracture can be treated conservatively in a plaster cast or by surgery. The indication for a conservative approach are non-displaced scaphoid fractures. Due to the very slow healing of the fracture, the duration of the plaster therapy is extremely long.
For the first 6 weeks an upper arm plaster with thumb inclusion should be applied. If the X-ray image shows that the fracture has healed, a plaster cast of the forearm with thumb inclusion can be used. Painkillers can also be used to treat scaphoid pain.
X-rays should be taken after one day, after one week, then after the 6th and 12th week. Despite optimal follow-up treatment, there are cases in which conservative treatment does not allow the fracture to heal. Surgical treatment should be performed in cases of displaced fractures, especially oblique and transverse fractures, as the probability of fracture healing is higher in these cases.
Surgical treatment should also be performed if there are capsule or ligament components in the fracture gap which could interfere with fracture healing. A further indication for surgical therapy is the lack of fracture healing after 12 weeks of conservative therapy or the circulatory disturbance of the boiling part near the wrist (proximal fragment). Special screws are now available for the initial surgical treatment of scaphoid fractures.
First both bone parts are threaded with a wire and brought together again in an ideal fit (puzzled together) and then a hollow screw (cannulated screw) is drilled over and both fragments are pressed together as a traction screw. Sometimes the wire is not used during the operation and the fragments are screwed directly (e.g. Herbert screw). However, this is also followed by a 4 – 6 week immobilization in plaster as a follow-up treatment.
A general resilience is achieved after approx. 10 weeks. A maximum sporting load can usually only be achieved again after 4 – 6 months.
After removal of the cast, physiotherapeutic and occupational therapy should be started immediately. In the case of old fractures that have not grown together for months or years (so-called pseudarthrosis), a screw connection is no longer sufficient. In these cases, living bone must be “borrowed” from the patient’s iliac crest.
Old scar tissue is removed from the fracture gap and a fresh block of bone is bolted in from the pelvic bone. The surgical technique is called Matti-Russe after the initial description, sometimes also called Matti-Russe plastic surgery. In addition to the “classical risks” of surgical therapy such as infection, wound healing disorder, thrombosis, embolism, numbness and paralysis, Sudeck’s disease is feared in the hand area. More about Sudeck’s disease can be found under vegetative reflex dysthrophy.
