The Scaphoid is a small kidney bean shaped bone in the wrist that is vulnerable to injury, especially in high-energy situations as British Superbike rider Dan Linfoot discovered after a crash during round 6 of the championship at Brands Hatch. As the photos show he was lucky that the accident wasn’t more serious.
The Scaphoid although small has a number of extremely important functions within the wrist including preventing the wrist from buckling under pressure. It is also unique in that the bone is almost entirely covered with articular cartilage, this means that it is unable to heal in the same way that most broken bones would and so must be kept absolutely still so new bone formation can occur across the fracture site. This coupled with the fact that the Scaphoid has a very poor blood supply means that it can often take 10-12 weeks of immobilisation in a plaster to heal. If the bone fails to heal (a non-union) then due to the alteration in wrist biomechanics patients will often go on to develop a well recognised pattern of arthritis in the wrist know as a SNAC wrist (Scaphoid non-union advanced collapse). This is not something that happens immediately but over a period of years following the injury. This means that if cast immobilisation has been unsuccessful then an operation to add bone graft to the fracture site and stabilise it can be done to prevent a SNAC wrist in the future.
Treatment of an acute un-displaced fracture is either in a plaster to immobilise the wrist or the Scaphoid can be fixed using a special type of orthopaedic screw (a variable pitch headless compression screw). The screw is placed under x-ray guidance in the operating theatre through a very small incision of only 1-2 mm. The implant then compresses the fracture and provides the stability that the fracture needs to heal without the need for a plaster cast. This should in turn allow a faster return to normal activities, or in Dan’s case we are hoping to get him back on his bike for round 9 at Silverstone.
Finger joint replacements can be a great way of alleviating the pain of arthritis whilst allowing you to retain or even improve the function of your hand. Below is a patients experience of the procedure and the recovery afterwards. If you would like to discuss anything you read here further or think that you may be a candidate for the procedure please contact me to arrange a consultation.
Over the last 5 years I have been increasingly troubled by arthritis in the wedding ring finger causing considerable joint swelling and pain. My two main hobbies are playing the violin, and golf, both of which were becoming impossible. Following consultation with my GP, I was referred to Edward Powell Smith at The Duchy, Harrogate. The consultation was extremely positive in respect of joint replacement and I was booked in for an operation in June 2016.
The op was carried out under local anaesthetic, whereby my arm was numbed. During the operation, which lasted less than an hour, I felt no discomfort whatsoever.
Within a week, the stitching was beginning to settle and I was referred to Emma Leather at Physio Action in Harrogate. This was initially a painful experience but movement and exercise are imperative for recovery.
Within a month, finger movement had improved considerably and the swelling was reducing. The key is constant joint exercise.
Within 3 months I was back to playing the violin and swinging a golf club (with care). Within 6 months I was carrying out almost entirely normal activities.
A remarkable recovery, when I had originally given up hope of ever playing the violin playing and golf again.
With winter here and the icy weather setting in trips, slips and falls are all too common. Instinctively we put out our arms to break the fall meaning that your wrist will all to often bare the full brunt of the impact. Broken wrists are very common and account for up to a quarter of all fractures seen in adults.
If you are unfortunate enough to have injured your wrist then it is likely that you will have been to the Emergency Department and had your arm put into a plaster cast. The initial plaster is a back slab or half plaster, secured with a bandage to allow any swelling to settle whilst holding the break still for pain relief and to allow healing.
The most important thing to do at this point is keep your hand elevated, higher than the level of your heart, and gently work your fingers into a fist. This will help to settle the swelling and prevent against stiffness.
If your wrist is badly broken then it may require an operation to restore the normal alignment. The aim of surgery is to stabilize the broken fragments into their original anatomical position to give the best possible outcomes. This is especially important if the break involves the smooth joint surfaces that need to be accurately restored. After surgery elevation and finger movement is the critical thing for the first week. At that point the plaster cast is usually removed and a lightweight splint used in combination with early movement of your wrist.
It takes about 6 weeks for most broken bones to heal. If you have had surgery then the implant supports the healing bone on the inside in the same way as a cast does on the outside. This allows early movement but you still need to be careful until the bone has fully healed.
If you would like to find out more or have been unlucky enough to have had an injury and wish to discuss options for treatment if you then please call to book an appointment. 01423 226580