Further Outpatient Care
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.
Patients with nondisplaced fractures treated with casting can return to full activity. Athletes and workers involved in heavy labor should continue to wear protection for 2 months after radiographic healing is complete.
Inpatient & Outpatient Medications
See the list below:
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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.
Deterrence
See the list below:
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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.
Complications
See the list below:
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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.
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Degenerative arthritis of the radiocarpal joint
Prognosis
See the list below:
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Using nonoperative casting technique, the expected rate of union is 90-98% within 10 weeks.
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Prognosis is less favorable if the fracture is displaced, diagnosis is delayed, or the fracture is in the proximal or the middle third of the scaphoid bone.
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Avascular necrosis develops in 30-40% of nonunion scaphoid fractures, most frequently in fractures of the proximal third of the scaphoid bone.
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Fractures of the middle third of the scaphoid heal in 6-12 weeks, on average.
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Distal-third fractures of the scaphoid heal in 4-8 weeks, on average.
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Proximal-third fractures of the scaphoid heal in 12-20 weeks, on average.
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Chronic pain, decreased ROM, and decreased grip strength may result.
