Chapter 12 Scaphoid Fractures
Surgical Overview
• The scaphoid is divided anatomically into four parts: the proximal pole, waist, distal pole, and tuberosity.
• The majority of scaphoid fractures occur through the waist (70%), followed by the proximal pole (20%), with the least occurring at the distal pole (10%).
• Although 90% to 95% of scaphoid fractures will heal if treated adequately with immobilization, 5% to 10% result in a nonunion.
• Reduction of scaphoid fractures can be accomplished via several means, depending on the nature of the fracture.
2 Fractures that are minimally displaced may be treated with closed reduction and percutaneous pinning (CRPP).
• The distal pole of the scaphoid has a rich blood supply in comparison to the proximal pole. Fractures at the scaphoid waist can disrupt the blood supply to the proximal pole and contribute to avascular necrosis, delayed union, or nonunion.
• Because of the poor blood supply, proximal pole scaphoid fractures take between 12 and 14 weeks to heal and require prolonged immobilization. Therefore, ORIF with a cannulated screw is commonly used to allow for early mobilization even when adequate reduction can be achieved with a closed manipulation.
2 A cannulated screw inserted into a threaded washer provides compression across the fracture site to provide stability as it heals.
3 A nonvascularized or vascularized bone graft may be used for complex fractures to accelerate bone healing.
Rehabilitation Overview
• The amount of surgical stability achieved, as well as the location of the scaphoid fracture, determine the rate of progression of therapy in each phase of healing.
• Direct communication with the doctor is essential to determine the location and stability of the fracture for appropriate therapeutic progression.
Postoperative Phase I: Protective (Weeks 0 to 4)
