Scaphoid Fracture Open Reduction and Internal Fixation (ORIF)
The most frequently fractured wrist bone is the scaphoid bone, which is located below the thumb joint. When a scaphoid bone is broken or fractured, it is difficult for it to heal on its own. If a piece of it breaks off, this can cause a lot of problems. The scaphoid bone is one of the essential bones of the wrist. If a scaphoid fracture occurs, most doctors recommend it be repaired through minimally invasive hand surgery.
How does a scaphoid fracture occur?
A scaphoid fracture can occur in many ways, but generally it happens when a person falls and tries to catch themselves with their hand. This bone is longer, so it tends to snap when placed under pressure. Most people don’t know right away when they break their scaphoid bone, but it is usually painful and can make it difficult to use the wrist. The scaphoid bone helps control the other wrist bones and the radius bone of the arm, so if it is fractured, even the arm can be difficult to use without pain. A doctor can easily diagnose a scaphoid fracture with an x-ray of the hand.
Basics of Scaphoid Open Reduction and Internal Fixation (ORIF)
Once the doctor has diagnosed a scaphoid fracture, they will refer the patient to receive ORIF surgery as soon as possible. This surgery repairs the scaphoid fracture through a simple procedure. “Open Reduction” means that the surgery is done with an open incision to expose the injured bone, and “Internal Fixation” means that the bone will be repaired with surgical hardware, usually screws, metal rods, or pins.
The patient will be placed under anesthetic and the hand will be cleaned and sterilized. A tourniquet is placed above the wrist to minimize blood loss. The surgeon will then make an incision to expose the scaphoid bone. Next, a fluoroscope will be used. A fluoroscope is a machine that takes a real-time x-ray. This will help the doctor see the inside of the bone and make sure they are correctly aligning the fractured pieces. Then, the surgeon will place a guide wire through the bones, leading up to the thumb bones. This keeps everything together while the hardware is placed. The doctor then repairs the scaphoid bone. Once this has been secured, the guide wire is removed, and the incision site is closed. The hand is then bandaged, and the patient is usually allowed to return home shortly after the surgery is completed.
Recovery after Scaphoid ORIF Surgery
Once the surgery is complete, the patient is encouraged to keep the wrist elevated as much as possible in the first few days to help reduce inflammation and swelling. Pain medicine can be prescribed, or over the counter medications are recommended. Depending on the severity of the initial injury, some doctors may also place the wrist in a cast after the swelling has gone down, to further promote healing and bonding of the scaphoid bone. The surgical site should be healed after a few weeks. Complete healing of the wrist takes about twelve weeks, but it can take longer depending on the aftercare of the patient. Once the wrist has mostly healed, most doctors prescribe physical therapy to avoid stiffness.
Long Term Effects
The most common long-term side effect of scaphoid fracture open reduction and internal fixation is stiffness of the wrist. This can be helped through physical therapy and other treatments, but some people still experience this for many years afterwards. This loss of motion is usually no greater than 10-15%, so it is definitely not debilitating. One of the biggest risks of this surgery is actually the small chance that the bone will not bond back together, known as nonunion. This can be extremely painful and may need another surgery to correct. Luckily, nonunion is rare and mostly occurs in cases where the scaphoid bone is fractured but no ORIF surgery is performed. Most people regain the use of their wrist and enjoy a healthy and safe recovery!