A fracture that has failed to heal in plaster after 3 months (Non-union).
An unstable or displaced fracture.
If one wants to avoid plaster treatment.
When the Scaphoid fractures it tends to crush into itself. With the crushing, the normal bean shape of the Scaphoid is converted to an L-shape (i.e. it becomes more angular).
In order to regain the normal shape the defect in the bone needs to be filled with bone graft removed from the pelvis through a small incision. With longstanding fractures that have failed to heal (non-unions), cysts form at the fracture site and the bone in this area resorbs. For this reason bone graft is also needed to fill the resultant defect in this situation. It is shaped accurately at the operation to fit the gap.
The operation involves admission to hospital for 2 days. The fracture site is identified and any remaining scar tissue removed. The fracture ends are cut to smooth surfaces and the resultant defect measured. Bone is then harvested from the pelvis and shaped accurately to fit the gap.
The fracture is then stabilised with wires and/or screws. The position of the fracture is checked on an x-ray machine in the operating room. Drains are inserted in the wounds and removed after 24 hours.
Long acting local anaesthetic is inserted into the hip wound. A half plaster is then applied.
The major problem is that the fracture fails to heal. This occurs in approx 5-10% of cases.
The other concern after any hand surgery is excessive swelling resulting in the dressings or plaster becoming too tight. In general if the plaster feels too tight it is.
Please read the handout sheet on Hand Surgery prior to coming into Hospital.