Scaphoid Fracture Nonunion

Scaphoid fractures are common injuries affecting the small, boat-shaped bone in the wrist known as the scaphoid. This bone plays a pivotal role in wrist movement and stability. When a scaphoid fracture occurs, timely and appropriate treatment is essential to prevent complications such as bone nonunion. Scaphoid nonunion refers to the failure of a fractured scaphoid bone to heal correctly, leading to persistent separation of the fractured ends. Several factors, including delayed or inadequate initial treatment, the location and severity of the fracture, and individual variations in healing, can contribute to the development of scaphoid nonunion.

Treatments for Scaphoid Fracture Nonunion

Identifying a scaphoid fracture can be challenging, as symptoms may mimic those of a sprained wrist. Common symptoms include:

  • Pain 
  • Swelling 
  • Tenderness
  • Difficulty gripping objects
  • Limited wrist movement

The severity of scaphoid fractures can vary. Some cases heal well with conservative measures, while others may require surgery. The condition is not always progressive, but delayed or inadequate treatment can increase the risk of complications. If you experience persistent pain, swelling, or difficulty moving your wrist after a scaphoid fracture, we encourage you to see a specialist for treatment.

Non-Surgical Treatments


Immobilization Through Casting or Splinting

This non-surgical treatment often involves immobilizing the wrist using a cast or splint to help stabilize the fractured scaphoid bone, promoting natural healing over time.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Medications like ibuprofen or naproxen may be recommended to manage pain and reduce inflammation associated with scaphoid fractures. These drugs can improve comfort and facilitate the healing process.

Hand Therapy or Physical Therapy

Physical therapy focuses on exercises and interventions to improve wrist strength, flexibility, and function. Hand therapists may guide individuals through specific movements that promote healing and restore optimal wrist functionality.


Surgical Treatments


Open Reduction and Internal Fixation (ORIF)

Open Reduction and Internal Fixation (ORIF) is a surgical procedure used to treat scaphoid fractures. During ORIF, the surgeon precisely realigns the fractured bones and secures them in place with internal fixation devices such as screws or plates. By providing stability to the fractured site, ORIF facilitates proper bone healing, reducing the risk of complications such as nonunion. This technique is particularly effective in cases where the fracture is displaced or requires precise alignment for optimal recovery.

Bone Grafting

Bone grafting is a surgical procedure involving the transplantation of healthy bone tissue to the site of a nonunion. This procedure serves multiple purposes, including providing a scaffold for new bone growth, stimulating the healing process, and addressing bone loss. The transplanted bone may be sourced from the patient (autograft), a donor (allograft), or synthetic materials. By introducing viable bone tissue, bone grafting enhances the chances of successful healing in cases where nonunion has occurred.

Revision Surgery

In situations where initial surgical interventions, such as ORIF, have not yielded the desired outcome, revision surgery may be necessary. Revision surgery involves reassessing the condition and addressing any issues that may be hindering proper bone healing. This may include removing hardware that is impeding progress, addressing infections, or exploring alternative techniques to promote successful bone union. The decision for revision surgery is made based on careful evaluation of the individual case, ensuring that the most appropriate measures are taken to achieve optimal healing and functional recovery.


Why Patients Trust the Center for Hand & Upper Extremity Surgery

Our advanced outpatient surgery centers are led by renowned orthopedic and plastic surgeons who specialize exclusively in hand, wrist, and arm procedures. Collectively, we perform hundreds of surgeries each year to correct upper extremity fractures and non-healing or nonunion fractures. 

When to Seek Medical Attention

If you suspect a scaphoid fracture due to symptoms like persistent pain, swelling, or difficulty moving your wrist after an injury, it's crucial to seek medical attention promptly. Early diagnosis and intervention significantly improve the chances of a successful recovery and reduce the risk of complications like bone nonunion. 


What causes a scaphoid Fracture?

The scaphoid bone, situated on the thumb side of the wrist, is prone to fractures due to its anatomical location and shape. These fractures typically occur when individuals fall onto an outstretched hand, directly impacting the wrist. The injury is often associated with sports such as skateboarding or snowboarding.

Can scaphoid nonunion occur even with proper initial treatment?

While proper initial treatment significantly reduces the risk of nonunion, individual variations in healing response can still lead to nonunion in some cases. Regular follow-ups with healthcare professionals are crucial to monitor healing progress.

How long does it take for scaphoid nonunion to develop after a fracture?

Scaphoid nonunion may take weeks to months to become apparent. It is essential to seek prompt medical attention if persistent symptoms such as pain and swelling occur after a scaphoid fracture, as early intervention can prevent nonunion.

Are there complications associated with surgical treatments for scaphoid nonunion?

Complications may include infection, hardware-related issues, or stiffness. However, the overall risk is generally low, and the benefits of surgery in treating scaphoid nonunion often outweigh potential complications.

HUES Surgeons

Get back on the road to recovery.