How do I treat a broken scaphoid
Does a scaphoid fracture have to be operated on, or is immobilization in a special plaster cast sufficient?
The primary goal of therapy is to ensure that the scaphoid fracture heals in order to prevent the long-term consequences of a lack of bone healing. The decisive factor here is the division of the scaphoid fractures into stable and unstable fractures. Stable scaphoid fractures can be immobilized in a special forearm cast including the wrist and the metacarpophalangeal joint. The plaster treatment usually takes about 6-12 weeks due to the slow healing of the bones. In order to justify treatment in a plaster cast, a computed tomogram should always be available to rule out any displacement of the fragments or debris zones. If the patient wishes a shorter treatment time, the stable scaphoid fracture can also be operated on. However, the majority of scaphoid fractures can be classified as unstable on the basis of computed tomography. Unstable fractures should always be surgically stabilized because of the high risk of failure to heal with the development of pseudarthrosis.
All stable and the majority of unstable fractures can now be treated with minimally invasive methods. After placing a guide wire, the fracture is stabilized by inserting a cannulated titanium screw through an approx. 1.0 cm long skin incision over the distal navicular pole. As a rule, a plaster restraint is then necessary for a maximum of 1-2 weeks. Depending on the pain, an elastic bandage is also sufficient. The wrist should be spared for up to 6 weeks during this procedure. Removal of the screw is only necessary in exceptional cases.
Fractures in the proximal third close to the body are operated on from the back of the hand. The ends of the fracture are fitted under sight and the fracture is stabilized with the small Herbert screw and the screw is inserted through the small fragment with the small Herbert screw.In rare cases, e.g. with compressed fractures, bone material (usually taken from the spoke) must be inserted into the fracture gap. As with the minimally invasive technique, the removal of the screw is only necessary in exceptional cases. In addition to regular controls of the wound and skin conditions, X-ray controls are required to monitor the healing of the fracture.
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