Scaphoid Fractures and Scapholunate Ligament Injury
What is it?
The scaphoid bone is one of a number of small, cartilage-covered bones, which together form the basis of providing finely controlled movements in the wrist and thumb. For a structure about the size of a monkey nut, it can cause a considerable amount of pain and disability if injuries are missed.
The scaphoid is at risk when a fall is sustained on an outstretched hand. As the injury may be difficult to see on regular x-rays, persistent pain is an indication to pursue further tests. If the bone isn’t broken, the integrity of the main ligament attaching it to adjacent bones needs to be assessed, as injury to the scapholunate ligament can alter the close-knit linkages within the wrist and lead to a post-traumatic arthritis.
The peculiar anatomy of the scaphoid leaves it at risk of not healing (non-union) or delayed healing as its blood supply may be jeopardised by the original fracture. It may take 8-12 weeks for the fracture to heal and in that time the injury can be supported by a plaster cast.
Percutaneous scaphoid fixation allows the wrist to be freely moved though caution is still required for the duration of the healing process. This day case procedure involves a general anaesthetic and a small ‘stab’ incision to allow a wire and then a screw to be passed across the fracture in a minimally invasive fashion. A single stitch closes the wound.
Scapho-lunate ligament injuries range from minor tears that can be dealt with via day case keyhole surgery to major disruption that requires scapholunate ligament reconstruction with tendon borrowed from elsewhere in the wrist. This latter procedure has the support of a plaster cast for 4-6 weeks followed by removable splintage and intensive hand therapy for a similar period.
Surrey Orthopaedic Clinic
Scaphoid Fractures and Scapholunate Ligament Injury Specialists: