Scaphoid Fracture 5 months (8 weeks immob)

[daemoe]

G'day, ill give you a quick run down of the patients history.

21 y.o male, non displaced fracture of distal pole of scaphoid 5 months ago following sporting injury. Signs/symptoms: Pain only on Flexion and Extension Over pressures. Minimal snuffbox pain. Initial diagnosis was scaphoid lunate ligament sprain.

X-ray confirmed Fracture 8 weeks ago. placed in an immobilisation cast for 8 weeks. 8 week later, Progress Xray shows that fracture line is still present however not as definate as it was before. Dr ordered removal of cast and gentle rom x's and strengthening.

After removal of cast, obvious decrease in ROM and strength. HOWEVER, there remain some minimal pain in the anatomical Snuff box, and thats just when i dig my fingers in quite hard. Pain isnt on other hand however.

My question is, is this pain in the snuff box concerning? Is it wise just to cointinue on with gentle ROM Exercises?

Cheers Damien.

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[zymotik]

I would like to know the answer to this too. I fractured my scaphoid bone 7 months ago. After 4-5 weeks in a cast from the day after it happened, then 5 weeks supported by a splint, I still have pain. Not as bad as when I did it, but lately it is getting to that point. I have not been able to do a press up since the fracture. Is this normal? Thanks, Ian

[Josephine]

Well, typically, scaphoids fractures can be difficult to get healed, even if they are undisplaced. Being shaped like a pair of peanuts in a shell with the break occurring in the 'neck', the two ends, though still held in place by the bone capsule, are not easily held together. Thus healing can be 'delayed'. This does show up in an xray but needs a trained eye to see it. Regular doctors are not often experienced in that field.

I would therefore suggest you report your continued symptoms to a reputable hand surgeon for a investigation including a check xray. If my suggestions prove true, then a bone graft or screw fixation could be necessary.

Tip - the longer you leave it, the more difficult it will be to resolve it.

[daemoe]

6 weeks after removal of a cast, and still experiencing the same pain as before the application of the cast, i decided to get a CT scan and wrist specialist's opionion on the matter. the CT scan showed obvious fracture line, however it was apparent that on some of the views there was some cross links. Because of this and the fact that i still had reasonable function in the wrist, the specialist advised that it would be wise to let it go for 6 weeks with restriction on high impact activities.

6 weeks later and pain is minimal and specialist believes that the scaphoid is fully healed, thus removal of restirctions.

All is good now

[zymotik]

Josephine, thanks for the advice. I have an appointment booked with my GP on Monday, he's pretty good so I'm hoping he will refer me for a more serious checkup.

Do you think I would be better being referred to the hand surgeons or the fracture clinic? They bounced me back and fourth last time and I ended up at the fracture clinic for treatment.

Thanks again. Ian.

[Josephine]

Depends how your hospital works. At my hospital, the hand surgeons have clinics in the Fracture Clinic and all hand injuries are referred to them as a matter of course. Personally I'd pitch for a hand surgeon ....

Additional Comment I forgot:

6 weeks later and pain is minimal and specialist believes that the scaphoid is fully healed, thus removal of restirctions.

All is good now

Excellent! I am very pleased for you.

[zymotik]

Went to the GP this morning. He did a blood pressure test. After that he checked for pain by pressing in the 'snuff box' area, which didn't hurt.(Pressure on the top of my wrist while hand slightly bent inward causes pain.) He referred me to the local hospital outpatients department for an x-ray, results due by letter in a week’s time.... (I noticed the xray machine was made circa 1970, no digital here!) I had a brief chat with the friendly staff there and they informed me that the GP cannot order a bone scan, fracture clinic have to do it. After being bounced back and forth from fracture clinic to hand surgery with this fracture last time, I'm unsure what will happen next........ I'm hoping the xray shows something up!


Attached pic shows where the pain is, between the blue dots. Pain is when flexing the wrist in any direction, getting out of a chair, or applying pressure to the area. No pain when picking something up or pulling on my fingers or thumb.






1 day old scaphoid fracture xray, left wrist and hand:

[Josephine]

That about says it, zymotic. And I think part of the fracture line is a comminuted fracture, not a clean break. This could complicate things when it comes to a primary healing.



As for the bone scan, yes that's the usual - they get ordered by ortho surgeons not GPs. Annoying but there it is.

[zymotik]

Wow, I never saw that. Thanks Josephine! Here is an x-ray taken on the 23rd July, 4 1/2 weeks after the fracture. I only just found it! Its a bit unclear as it is not the original like the other xray image.

I'm still waiting for the results from the x-ray on Monday.

Fractured 19th June 2009, cast 20th June, xray 23rd July after cast removal. X-ray left Scaphiod bone fracture:


Ian Brown

[zymotik]

Results came back negative for any fracture still present... hmmm!

Still have a bit of pain, not as bad as last week, so I'm going to give it another week and see how it feels. Doc says he'll happly refer me back to the hospital which is nice of him.

Thanks for all your help Josephine!

Ian Brown

[ammeep]

I broke my Scaphoid and Radius 7 months ago and have a very similar story to yours. I was in cast for 12 weeks and then removed and commenced physio.

I still cant load up my wrist with all my weight, but have returned to playing sport which causes me pain for days after. My physio says it ok as its strengthens my wrist.

This area constantly aches.

Lately I have been experiencing sharp pains in the area. Its not as bad as when I first broke it, but still bad. Typing for a long period of time is painful. Fine motion like using a brush when washing the dishes also causes intense pain

I have an xray and ultra sound next week. Will be interested to hear how your getting on.