Scaphoid non union

The scaphoid is a small bone found at the base of the thumb next to the wrist. It often fractures following a fall or twisting injury, but may not produce the degree of pain one would expect from a broken bone. These fractures occur frequently in sports injuries . As a result, people often play down their symptoms of wrist pain, thinking they have "just sprained it". The acute symptoms settle after a few weeks and the wrist may just be a bit stiff or sore.

If the scaphoid did break, it may never heal properly because it did not get early treatment (usually immobilisation in a cast). The broken edges of the bone at the fracture site become rounded and smooth, making healing impossible without treatment. This condition is called scaphoid non union. Scaphoid non union can also occur even if the correct treatment has been provided from an early stage, but this is unusual.

Scaphoid non union can give rise to symptoms of pain (either a general ache, pain on certain movements or with gripping), weakness and loss of power, and an inability to move the wrist fully. This can affect an individual's ability to work or participate in sport . There may be a vague swelling or 'fullness' to the wrist, and there may be no memory of any previous injury.

If a scaphoid non union exists, it is important for the doctor to assess both the age of the scaphoid non union, and its stage. Untreated, it is likely that scaphoid non union will result in wrist arthritis at an earlier stage than normal ageing would produce. A doctor will look for signs that this process is already underway because that will change the treatments that will be recommended. There is evidence to suggest that an untreated scaphoid non union will produce wrist arthritis within 5 years of the injury.

If there is no evidence that wrist arthritis is developing, an attempt will be made to get the scaphoid to heal surgically by using a bone graft and a metal screw. Traditionally, the bone graft will be taken from the iliac crest - the hip bone that you feel where your trouser belt sits. This bone graft must be detached from its blood supply to take it from hip to wrist, and also requires two separate scars. Mr Campbell performs a vascularised bone grafting procedure - where the bone graft is taken through the same surgical scar at the wrist and remains connected to its blood supply - giving theoretical advantages for healing. No scar is needed at the hip. Approximately 85% of scaphoid non union cases will heal with this treatment.

After surgery, a plaster cast is worn for 6 or 8 weeks, when work &/or driving may be difficult.

If there is evidence of early or established wrist arthritis, a bone grafting procedure is usually not recommended, but treatments for wrist arthritis will be offered.

For further information on scaphoid non union, use these links:

scaphoid non union info

scaphoid non union surgery (Warning: this link contains photographs of a real surgical procedure)