|
Sorry I didn't see this thread earlier.
Non-union of a scaphoid means internal fixation is a must.
The scaphoid has a tenuous blood supply entering distally. If you have a non-union, especially with a fracture through the waist of the scaphoid you can get necrosis of the proximal half of that scaphoid. When that happens, the geometry and function of the whole wrist will be affected.
Some years ago I was the lead theatre radiographer at a hospital here in London where a surgeon by the name of Nick Goddard was at the forefront of innovative internal fixation operations involving the scaphoid. He would do them with the thumb suspended in a Chinese finger puzzle, whilst I X-rayed it with live fluoroscopy, orbiting the scaphoid.
Back then he was using a headless compression screw with two opposing thread pitches. We are talking at least 10 years back. I screened many cases with that team, and got to hear about the dangers of non-union and all the complications.
So, upfront I'll advise that although I am not a doctor I have enough info to declare that if it was me I would want the surgery.
I've attached two images from one of the cases, showing the finger puzzle and the X-ray set-up. The C-arm is in an orbit parallel to the floor. If you look on the X-ray monitor you can see the fractured scaphoid with the screw traversing the fracture, but not yet turned to achieve full compression (the light fracture line through the waist is still visible).
At the end of the procedure the fracture is reduced.
|