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Scaphoid Injury Follow-up

  • Author: Scott R Laker, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
 
Updated: Apr 06, 2015
 

Further Outpatient Care

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  • Individuals with scaphoid injuries require outpatient rehabilitation in order to regain ROM and strength in their affected joints. The course of treatment depends on the severity and location of the fracture. Different protocols are followed for patients who are treated with nonoperative casting techniques than are employed for patients who have undergone surgical fixation. Please see the Physical Therapy section for a discussion of rehabilitation principles and considerations for scaphoid fractures.
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Inpatient & Outpatient Medications

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  • Oral analgesics should be sufficient to provide pain relief. Most commonly, NSAIDs are used along with acetaminophen. In some cases, narcotics may be used for 1-2 weeks. Tramadol also may be helpful for the first few weeks.
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Deterrence

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  • Encourage wrist protection and falling precautions when the patient engages in sporting activities, especially ice-skating, skateboarding, or in-line skating.
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Complications

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  • Aseptic necrosis - A higher incidence of aseptic necrosis and nonunion occurs with fractures of the proximal pole of the scaphoid, because no blood vessels enter it.
  • Degenerative arthritis of the radiocarpal joint
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Prognosis

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  • Using nonoperative casting technique, the expected rate of union is 95% within 10 weeks.
  • Prognosis is less favorable if the fracture is displaced, diagnosis is delayed, or the fracture is in the proximal or perhaps the middle third of the scaphoid bone.
  • Avascular necrosis develops in 30-40% of nonunion scaphoid fractures, most frequently in fractures of the proximal third of the scaphoid bone.
  • Fractures of the middle third of the scaphoid heal in 6-12 weeks, on average.
  • Distal-third fractures of the scaphoid heal in 4-8 weeks, on average.
  • Proximal-third fractures of the scaphoid heal in 12-20 weeks, on average.
  • Chronic pain, decreased ROM, and decreased grip strength may result.
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Patient Education

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  • That patient should be informed that degenerative arthritis of the wrist probably is inevitable, but this condition may take years to develop, depending on the amount of chronic stress applied to the wrist.
  • Appropriate follow-up and aggressive rehabilitation should be emphasized to the patient.
  • For excellent patient education resources, see eMedicineHealth's patient education articles Broken Hand and Wrist Injury.
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Contributor Information and Disclosures
Author

Scott R Laker, MD Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine; Medical Director, Lone Tree Health Center

Scott R Laker, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Robert Irwin, MD Consulting Staff, Florida Orthopaedic Institute

Robert Irwin, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Physiatric Association of Spine, Sports and Occupational Rehabilitation, American College of Physicians, Association of Academic Physiatrists, North American Spine Society

Disclosure: Nothing to disclose.

Deborah Saint-Phard, MD Associate Professor, Department of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Director, CU Women's Sports Medicine Program, University of Colorado Denver School of Medicine, Aurora, Colorado

Deborah Saint-Phard, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Colorado Medical Society, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor and Interim Chair of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Additional Contributors

J Michael Wieting, DO, MEd, FAOCPMR, FAAPMR Senior Associate Dean, Associate Dean of Clinical Medicine, Consultant in Sports Medicine, Assistant Vice President of Program Development, Division of Health Sciences, DeBusk College of Osteopathic Medicine; Professor of Physical Medicine and Rehabilitation, Professor of Osteopathic Manipulative Medicine, Lincoln Memorial University-DeBusk College of Osteopathic Medicine

J Michael Wieting, DO, MEd, FAOCPMR, FAAPMR is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, American Osteopathic Academy of Sports Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Maria Carmen E Espiritu, MD, PT Consulting Staff, Espiritu Clinic, Clinch Valley Medical Center

Maria Carmen E Espiritu, MD, PT is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and American Medical Association

Disclosure: Nothing to disclose.

References
  1. Duckworth AD, Jenkins PJ, Aitken SA, Clement ND, Court-Brown CM, McQueen MM. Scaphoid Fracture Epidemiology. J Trauma. 2011 Oct 13. [Medline].

  2. Cheung GC, Lever CJ, Morris AD. X-ray diagnosis of acute scaphoid fractures. J Hand Surg [Br]. 2006 Feb. 31(1):104-9. [Medline]. [Full Text].

  3. Toth F, Sebestyen A, Balint L, et al. Positioning of the wrist for scaphoid radiography. Eur J Radiol. 2007 Oct. 64(1):126-32. [Medline].

  4. Beeres FJ, Hogervorst M, Rhemrev SJ, et al. A prospective comparison for suspected scaphoid fractures: bone scintigraphy versus clinical outcome. Injury. 2007 Jul. 38(7):769-74. [Medline].

  5. Hannemann PF, Brouwers L, Dullaert K, et al. Determining scaphoid waist fracture union by conventional radiographic examination: an analysis of reliability and validity. Arch Orthop Trauma Surg. 2015 Feb. 135(2):291-6. [Medline].

  6. Tibrewal S, Jayakumar P, Vaidya S, Ang SC. Role of MRI in the diagnosis and management of patients with clinical scaphoid fracture. Int Orthop. 2011 Sep 7. [Medline].

  7. Ng AW, Griffith JF, Taljanovic MS, Li A, Tse WL, Ho PC. Is dynamic contrast-enhanced MRI useful for assessing proximal fragment vascularity in scaphoid fracture delayed and non-union?. Skeletal Radiol. 2013 Jul. 42(7):983-92. [Medline].

  8. Bervian MR, Ribak S, Livani B. Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery: diagnosis of scaphoid pseudarthrosis. Int Orthop. 2015 Jan. 39(1):67-72. [Medline].

  9. Beeres FJ, Hogervorst M, den Hollander P, et al. Outcome of routine bone scintigraphy in suspected scaphoid fractures. Injury. 2005 Oct. 36(10):1233-6. [Medline].

  10. Beeres FJ, Hogervorst M, Rhemrev SJ, et al. Reliability of bone scintigraphy for suspected scaphoid fractures. Clin Nucl Med. 2007 Nov. 32(11):835-8. [Medline].

  11. Karantanas A, Dailiana Z, Malizos K. The role of MR imaging in scaphoid disorders. Eur Radiol. 2007 Nov. 17(11):2860-71. [Medline].

  12. Jenkins PJ, Slade K, Huntley JS, et al. A comparative analysis of the accuracy, diagnostic uncertainty and cost of imaging modalities in suspected scaphoid fractures. Injury. 2008 Jul. 39(7):768-74. [Medline].

  13. Brooks S, Cicuttini FM, Lim S, Taylor D, Stuckey SL, Wluka AE. Cost effectiveness of adding magnetic resonance imaging to the usual management of suspected scaphoid fractures. Br J Sports Med. 2005 Feb. 39(2):75-9. [Medline]. [Full Text].

  14. Moller JM, Larsen L, Bovin J, et al. MRI diagnosis of fracture of the scaphoid bone: impact of a new practice where the images are read by radiographers. Acad Radiol. 2004 Jul. 11(7):724-8. [Medline].

  15. Finkenberg JG, Hoffer E, Kelly C, et al. Diagnosis of occult scaphoid fractures by intrasound vibration. J Hand Surg [Am]. 1993 Jan. 18(1):4-7. [Medline].

  16. Brotzman SB, Wilk KE, eds. Handbook of Orthopaedic Rehabilitation. 2nd ed. Philadelphia, Pa: Elsevier; 2007.

  17. Cohen MS, Jupiter JB, Fallahi K, Shukla SK. Scaphoid waist nonunion with humpback deformity treated without structural bone graft. J Hand Surg Am. 2013 Apr. 38(4):701-5. [Medline].

  18. Capo JT, Shamian B, Rizzo M. Percutaneous screw fixation without bone grafting of scaphoid non-union. Isr Med Assoc J. 2012 Dec. 14(12):729-32. [Medline].

  19. Dinah AF, Vickers RH. Smoking increases failure rate of operation for established non-union of the scaphoid bone. Int Orthop. 2007 Aug. 31(4):503-5. [Medline]. [Full Text].

  20. Dias JJ, Dhukaram V, Abhinav A, et al. Clinical and radiological outcome of cast immobilisation versus surgical treatment of acute scaphoid fractures at a mean follow-up of 93 months. J Bone Joint Surg Br. 2008 Jul. 90(7):899-905. [Medline].

  21. Munk B, Larsen CF. Bone grafting the scaphoid nonunion: a systematic review of 147 publications including 5,246 cases of scaphoid nonunion. Acta Orthop Scand. 2004 Oct. 75(5):618-29. [Medline].

  22. Huckstadt T, Klitscher D, Weltzien A, et al. Pediatric fractures of the carpal scaphoid: a retrospective clinical and radiological study. J Pediatr Orthop. 2007 Jun. 27(4):447-50. [Medline].

  23. Katzung BG, ed. Basic and Clinical Pharmacology. 9th ed. New York, NY: Lange Medical Books/McGraw Hill; 1995.

  24. Breederveld RS, Tuinebreijer WE. Investigation of computed tomographic scan concurrent criterion validity in doubtful scaphoid fracture of the wrist. J Trauma. 2004 Oct. 57(4):851-4. [Medline].

  25. Canale ST, ed. Campbell's Operative Orthopaedics. 10th ed. St Louis, Mo: Mosby; 2003.

  26. Cuenod P, Charriere E, Papaloizos MY. A mechanical comparison of bone-ligament-bone autografts from the wrist for replacement of the scapholunate ligament. J Hand Surg [Am]. 2002 Nov. 27(6):985-90. [Medline].

  27. Dias JJ, Wildin CJ, Bhowal B, Thompson JR. Should acute scaphoid fractures be fixed? A randomized controlled trial. J Bone Joint Surg Am. 2005 Oct. 87(10):2160-8. [Medline]. [Full Text].

  28. Hoppenfeld S, Murthy VL. Treatments and Rehabilitation of Fractures. Philadelphia, Pa: Lippincott Williams & Wilkins; 2000.

  29. Hunter JM, Mackin EJ, Callahan AD. Rehabilitation of the Hand: Surgery and Therapy. 4th ed. St Louis, Mo: Mosby; 1995.

  30. Kumar S, O'Connor A, Despois M, et al. Use of early magnetic resonance imaging in the diagnosis of occult scaphoid fractures: the CAST Study (Canberra Area Scaphoid Trial). N Z Med J. 2005 Feb 11. 118(1209):U1296. [Medline].

  31. Magee DJ. Orthopedic Physical Assessment. 4th ed. Philadelphia, Pa: Saunders; 2002.

  32. Oka K, Murase T, Moritomo H, et al. Patterns of bone defect in scaphoid nonunion: a 3-dimensional and quantitative analysis. J Hand Surg [Am]. 2005 Mar. 30(2):359-65. [Medline].

  33. Pao VS, Chang J. Scaphoid nonunion: diagnosis and treatment. Plast Reconstr Surg. 2003 Nov. 112(6):1666-76; quiz 1677; discussion 1678-9. [Medline].

  34. Bucholz RW, Heckman JD, Court-Brown CM. Rockwood and Green's Fractures in Adults. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2006.

  35. Senall JA, Failla JM, Bouffard JA, et al. Ultrasound for the early diagnosis of clinically suspected scaphoid fracture. J Hand Surg [Am]. 2004 May. 29(3):400-5. [Medline].

  36. Richmond JC, Shahady EJ, eds. Sports Medicine for Primary Care. Cambridge, Mass: Blackwell Science; 1996.

  37. Temple CL, Ross DC, Bennett JD, et al. Comparison of sagittal computed tomography and plain film radiography in a scaphoid fracture model. J Hand Surg [Am]. 2005 May. 30(3):534-42. [Medline].

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