The doctor. David Cecilia, a specialist in upper limb traumatology and surgery, explains in the following article the importance of properly diagnosing scaphoid injury so that it does not become a chronic wrist injury. The doctor. Cecilia is currently responsible for the hand and elbow surgery unit of the Hospital October 12 in Madrid and team leader of the Hand and Elbow and Arthroscopy Unit of the Mutuality of Footballers of the Madrid Delegation of the Spanish Football Federation.
The joints of the hand have a very complicated anatomy. This part of our body contains many ligaments intertwined with 8 small bones that constitute the carpus, with the metacarpals and towards the elbow with radius and ulna. One of the most important bones is the scaphoid , and its function is essential for the correct functioning of the hand. It can be touched by following the outer edge of the thumb just in the transition zone between the hand and the forearm.
The scaphoid fracture often occurs due to a sudden fall, blow or twist of the wrist. Since it is a bone with problems of vascularization, when these fractures are not treated properly, secondary lesions in the rest of the wrist originate in the medium-long term, which can be quite incapacitating.
Symptoms of Scaphoid Injury
Scaphoid fractures can cause pain and swelling of the wrist. The pressure in the bone (radius and scaphoid) causes intense pain to the patient. These fractures are relatively common in young people, especially manual workers and athletes suffering from falls or traffic accidents.
Can the scaphoid lesion be confused with other pathologies?
The problem is that sometimes the fracture of the scaphoid is not diagnosed, since it can be confused with a simple wrist sprain, even the X-rays can be normal and the fracture is not seen, requiring additional tests.
In these cases, when not treated properly and being a bone with intrinsic problems with respect to its vascularization, the fracture may not "stick", which in medicine is called Pseudoarthrosis .
Pseudoarthrosis at first may not give symptoms, but over time can cause osteoarthritis to develop in the hand and then it is when the patient consults being too late if this osteoarthritis is too advanced to do repair surgeries. In these cases, you often have to opt for palliative surgeries that consist of removing the pain to consist of removing mobility to the wrist.
Treatment of scaphoid fracture
Some fractures can be treated with immobilization with a cast, but most benefit from a surgical treatment that consists of placing a screw to "fracture". It is a walking procedure, does not require hospitalization and is done through the skin, with a 1-2 mm incision.
When a patient comes with pseudoarthrosis scaphoid, if it is still not a very developed box and no artosis, it proceeds to perform, by the specialist Traumatology , a reconstruction of bone placing a graft and fixing it with a screw until pseudoarthrosis cure. The type of graft depends on the case but can be divided generally into 2 types: picking it from the iliac crest of the patient or vascularized, which consists of obtaining the graft with its vessels.
In cases where osteoarthritis is already established and it is too late to reconstruct, palliative surgeries are performed, which usually consist of bone fusion to remove the pain in order to remove movement in the wrist partially or complete