See below for before and after photos. This patient came to Action Rehab with a traditional cast. We were able to fit them with a lightweight waterproof functional brace.
•Within 24 hours
•Urgent care required
Suggestion: X-ray & CT Scan
Thermoplastic wrist water proof orthosis full time. 6 weeks. CT at 6 weeks to determine healing. Core strengthening program commenced once CT confirms healing.
Movement of the thumb with supination and pronation have not been shown to be detrimental to the healing of the scaphoid in conservatively treated fractures, McAdams’ (2003) & Schramm et al (2008)
At Action Rehab The Hands Physio, we can fabricate a “splint” that works just like a really light “cast”. Patient experience is much improved with the thumb free to mobilise.
See below for before and after photos. This patient came to Action Rehab with a traditional cast. We were able to fit them with a lightweight waterproof functional brace.
See below the two treatment approaches for a patient who has a Scaphoid Fracture and needs treatment.
If a Scaphoid Fracture is stable (and most are) then a custom, lightweight, water resistant thermoplastic “cast” or “splint” with the thumb free to mobilise will be fabricated by your Hand Therapist at Action Rehab The Hands Physio.
A stable scaphoid fracture without displacement CAN be treated without surgery.
It is important to have a thorough assessment with your Hand Therapist as soon as you suspect a Scaphoid Fracture or a fall on the outstretched hand. Your Hand Therapist, Physiotherapist or Occupational Therapist at Action Rehab can read and understand your X-ray and your CT, they can assess the stability of the fracture and the need for immobilisation, thumb in or out. In the rare cases of Scaphoid Fracture where surgery is indicated then your Hand Therapist at Action Rehab can refer you to the appropriate surgeon to continue your care. Some scaphoid fractures do not require plaster and stable fractures may only require a wrist brace with no thumb immobilisation and no plaster required. Our Hand Therapists at Action Rehab are experienced in Scaphoid Fracture treatment and can offer you advice and management if you suspect you may have this injury.
Scaphoid fractures predominantly occur in young, active individuals, most commonly resulting from a fall on the outstretched hand. The scaphoid bone is the most important carpal bone in your wrist. Scaphoid fractures account for 79% of carpal fractures making it the most commonly injured bone in young adults.
This depends on how it is managed and assessed. Some Scaphoid Fractures can lead to non union and never heal causing other wrist problems and need reconstructive surgery. An undisplaced fracture of the scaphoid waist or distal (closer to the thumb) will most likely heal within 8 weeks in a well fitting wrist splint (cast). A distal pole fracture of the scaphoid will actually heal even faster than that and may heal within 6 weeks if managed in a well fitting splint (cast). Some scaphoid fractures are more complicated and your Hand Therapist at Action Rehab will be able to assess and advise on the management of the fracture and where required we can refer you to an appropriate surgeon who will operate on the scaphoid bone where required. A surgically repaired scaphoid should heal within 8 weeks as long as the repair is stable.
Yes, an undisplaced scaphoid fracture can heal without surgery as long as it is managed well in a splint. A displaced fracture or a fracture proximal (nearer the wrist) to the waist of the scaphoid generally needs surgical assessment and may require surgery to assist with healing. Post surgery a scaphoid is considered stable so the treatment is then the same as for non-surgical scaphoid fracture.
This depends on where the fracture/break is, treatment varies from the level of the fracture tip to toe however generally if the fracture is stable or has been stabilised with surgery then functional treatment in a water resistant wrist splint/cast (that can be removed if requested or can be secured to not be removed if it is indicated) with the thumb free to mobilise is how it is managed at Action Rehab. Exercises will start as soon as the fracture is healing (usually 6-8 weeks post injury) and strengthening will commence once the fracture is considered “healed”. It is important to assess a Scaphoid Fracture healing by performing a CT scan normally at the 8 week mark post injury. A CT scan will show the degree of healing but is unlikely to show “complete” union at the 8 week stage. Generally where there is a bridge on “union” measured on the CT then the fracture is likely to continue to heal and will not lead to “non union” which is the main complication of a scaphoid fracture.
Generally, the answer is no. However, where there is significant displacement of the fracture or the fracture is in the Proximal third of the bone then surgery is indicated. Surgery can also speed recovery in some cases and in those proximal pole fractures then a surgical assessment is important. Action Rehab hand therapists are able to read X-rays and CT scans and can advise where a surgical opinion is required.
The fastest way to heal a scaphoid fracture is with expert assessment of the fracture type and then balancing rest in a splint/cast with gentle movement and micro stress.
Yes if a scaphoid fracture is left untreated or poorly managed in a cast or fibreglass thumb spica can lead to serious complications, bone graft surgery, wrist reconstruction, bone removal. It is a really important bone in the wrist and needs the experts at Action Rehab hand therapy to assess and advise.
Hopefully you never wear a “cast” for a scaphoid fracture. Modern technology and treatment mean that we no longer need to tolerate a plaster or fibreglass “cast” and patients are much happier and much more comfortable when treated in a thermoplastic water resistant “cast” or splint that can be worn 100% of the time (just like a traditional “cast”. Some Dr’s think “splint” means removal but in fact, at Action Rehab, we can fabricate a “splint” that works just like a really light “cast” and the patient experience is much better and the treatment outcomes and healing are actually faster.