Trauma · Hand & wrist

Scaphoid fixation

Compression screw fixation of a scaphoid fracture to speed reliable healing of a bone notorious for nonunion.

Overview

Palmar dissection of the hand and wrist showing the eight carpal bones, flexor tendons, and median and ulnar nerves.
Hand and wrist anatomy. Eight small carpal bones form the wrist and connect the forearm to the five metacarpals of the palm. Finger tendons and the median and ulnar nerves pass through narrow tunnels in the wrist on their way into the hand.
Wilfredor · Wikimedia Commons · CC BY-SA 3.0

The scaphoid is a small wrist bone with a tenuous blood supply that enters from the distal end. A fracture — especially one through the middle (waist) or proximal pole — can cut off the blood supply to the proximal fragment and lead to nonunion or avascular necrosis.

Operative fixation is considered for displaced fractures, proximal-pole fractures, and fractures in active patients or athletes who want a shorter immobilization period. Cast treatment remains an option for non-displaced distal fractures, but healing times can exceed three months.

Why it's done

Scaphoid fixation is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:

  1. Displaced fracture

    Any displacement raises the nonunion rate significantly.

  2. Proximal-pole fracture

    Poor blood supply demands stable fixation.

  3. Delayed presentation

    A fracture that hasn't started to heal within a few weeks.

  4. Active or athletic patient

    To shorten immobilization and return to sport.

  5. Nonunion from prior non-operative care

    Requires fixation plus bone graft.

How it works

A headless compression screw is placed down the long axis of the scaphoid under fluoroscopic guidance. The approach can be either from the palm side (volar) or the back side (dorsal), depending on the fracture location.

For nonunion or avascular necrosis, a vascularized or non-vascularized bone graft is combined with the screw. Small incisions and percutaneous techniques are used when possible.

Recovery

The wrist is splinted for comfort for a week or two and then transitioned to a removable brace. Hand-therapy motion exercises begin once the wound is healed. Return to sports typically requires radiographic evidence of healing, often confirmed with a CT scan at three months. Return to work depends on demands. The screw is left in place unless symptomatic.

Contact

For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.

Further Reading

External patient-education references and related OSI pages for additional background: