Scaphoid internal fixation

A scaphoid fracture commonly occurs through a fall on an outstretched hand and is a fracture of a tiny bone at the base of the thumb joint. This can be repaired with open reduction and internal fixation surgery by Mr Kemble Wang. The fracture is commonly mended by Kemble using one or two screws to stabilise the fracture site. Depending on the pattern of fracture, surgery may be open (with a 4cm incision), percutaneous (through a 1cm incision), or via keyhole (arthroscopy). Depending on the age of the fracture, a bone graft may also be necessary.

 

Post-surgery, the incision will be closed using sutures and covered with a waterproof dressing. A plaster cast will also have been applied during surgery.

Post-operative rehabilitation (developed in conjunction with Melbourne Hand Therapy)

 

Rehabilitation following scaphoid ORIF surgery is highly dependent on the location of the fracture (waist, distal pole, proximal pole) and any associated carpal ligament injuries. For recovery to be successful, all these areas and ligaments must be protected to enhance healing.

 

Post-operatively, the arm will be in a sling and plaster cast. All dressings / bandages must remain intact and dry until a review by Kemble and a hand therapist. A plastic bag tied above the elbow to prevent the arm from getting wet can be used during showering, or alternatively a one-handed bath can be taken. Kemble will review the wound and advise when it is safe to get it wet.

 

Keep the arm elevated at all times when possible during the first few days following surgery. This helps reduce swelling. Use a pillow to prop the arm up if are seated or lying and a sling if up and about.  

Initial appointment (10-14 days post-operatively)

  • Removal of post-operative cast;

  • Wound check, dressing change, and wound desensitization;

  • Apply tubigrip (or similar) to wrist to reduce post-operative swelling;

  • A thermoplastic splint will be fabricated by the hand therapist for full time wear;

  • Patients should be encouraged to commence finger movement early and regularly and maintain movement of unaffected joints (shoulder, elbow) to avoid stiffness;

  • It is safe for patients to perform light functional tasks with their hand (e.g. eating, dressing, using phone), while still in the splint.

 

6 weeks post-operatively

  • An X-ray will be taken at the 6-week review to check healing;

  • At this time, patients can come out of their splint to commence active and passive range of motion;

  • There are 6 major wrist movements to regain: flexion/extension/pronation/supination/radial deviation/ulnar deviation. Mr Wang and/or the Hand Therapist will give instructions regarding these;

  • No weightbearing yet at this stage, and patients should stay be advised to stay in their splints for 70% of the time. Nothing heavier than a cup of tea should be lifted;

  • Some pain is normal when trying to move the wrist as it has been immobilised for some time;

  • Scar massage will begin at this stage;

  • No sports.

12 weeks post-operatively

  • A CT scan will be obtained at this stage. If this shows a successful union of the fracture, then patients can safely remove the splint and return to sport activities. However, as patients differ in their recovery and healing times, a return to normal sport and activities also varies and depends on the individual. The patients comfort level as well as the sport played is also a critical factor.

  • Once sufficient bone healing has occurred, patients can increase weight-bearing through the arm and Kemble will advise when there is sufficient bone recovery to safely resume normal activities and sport.

Possible complications of this procedure

  • Numbness and nerve sensitivity;

  • Fracture non-union (bone not healing), which may require revision surgery;

  • SNAC (Scaphoid Non-union Advanced Collapse) wrist;

  • Fracture malunion (bone healing in poor position).

©2020 Kemble Wang Orthopaedics

 

Disclaimer: All information provided on this webpage should be considered as general guidelines. Actual practice and (expected) outcomes may differ in your case. The contents has been created online for information purposes only. It is not intended to be a substitute for specific advice from either Kemble Wang or your other healthcare practitioners