Other possibilities for scaphoid fracture that doesn't heal?

[eric275]

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During my stint in the military I broke my left scaphoid as the result of a fall. I originally thought that it was just sprained and went on with life. Well about 2 years later it started to bother me more as a result of physical activity. After being evauluated it was determined that I had a fracture to my left scaphoid. A screw was inserted along with a bone graft to stimulate healing of the bone. The graft never took and the doc told me that eventually I would probably need to have my wrist fused as the scaphoid broke down and the wrist joint became arthritic.

This all took place ~10 years ago and I am now starting dental school this fall. The question is, have any of you heard of other possibilities that don't involve the fusing of my wrist? I have asked several dentists about the impact of having my wrist fused, but since it is my off hand they all thought that it wouldn't be a problem. Since the off hand mostly is ised for holding a mirror. But at 31 my wrist has been starting to bother me, popping and soreness, and I would really rather not have to get my wrist fused if at all possible. I do have an appt. to get a review of my wrist and new x-rays in 2 months but the "not-knowing" what my possibilities are is driving me crazy.

Thanks.

 

[eric275]

During my stint in the military I broke my left scaphoid as the result of a fall. I originally thought that it was just sprained and went on with life. Well about 2 years later it started to bother me more as a result of physical activity. After being evauluated it was determined that I had a fracture to my left scaphoid. A screw was inserted along with a bone graft to stimulate healing of the bone. The graft never took and the doc told me that eventually I would probably need to have my wrist fused as the scaphoid broke down and the wrist joint became arthritic.

This all took place ~10 years ago and I am now starting dental school this fall. The question is, have any of you heard of other possibilities that don't involve the fusing of my wrist? I have asked several dentists about the impact of having my wrist fused, but since it is my off hand they all thought that it wouldn't be a problem. Since the off hand mostly is ised for holding a mirror. But at 31 my wrist has been starting to bother me, popping and soreness, and I would really rather not have to get my wrist fused if at all possible. I do have an appt. to get a review of my wrist and new x-rays in 2 months but the "not-knowing" what my possibilities are is driving me crazy.

Thanks.

I found the answer to my question while searching the internet, it's called a Swanson Titanium Carpel Schaphoid Implant. Pretty interesting stuff, I'm providing the link if anyone is interested. After clicking on the link just click on the PDF link to view the information.

http://www.wmt.com/Physicians/Products/Extremities/SwansonTitaniumCarpalScaphoidImplants.asp

 

[volkl7]

there are only a few surgical options for a SNAC (scaphoid non-union advance collapse) wrist. it depends on how arthritic the joints around the scaphoid are; basically you may have a simple styloidectomy (resecting the radial styloid), or a proximal row carpectomy (taking out the scaphoid, lunate, and triquetrium); perhaps a four corner fusion depending on which joints are involved. last resort would be a wrist fusion.

 

[volkl7]

the wright scaphoid implant is probably indicated for wrists that have yet to exhibit degenerative changes. if you already have arthritic changes between scaphoid and radius, the implant won't do you much good as it will rub on the arthritic scaphoid fossa on the radius.

 

[AH11]

^^

 

[skiz knot]

I would go to a different hand surgeon for a second opionion. Look for one that can do vascularized grafts for your scaphoid. Despite being 10+ years out from your injury it may be worth a try. That may not be the best answer for your situation, but I would be very hesitant to have a titanium scapoid replacement. The other options previously mentioned (styloidectomy, proximal row carpectomy, various fusions) are all potentially good options as well and can leave you with good dexterity.
You need to have a long discussion with a good hand surgeon where you discuss your goals and expectations.

 

[Tired]

I would go to a different hand surgeon for a second opionion. Look for one that can do vascularized grafts for your scaphoid. Despite being 10+ years out from your injury it may be worth a try. That may not be the best answer for your situation, but I would be very hesitant to have a titanium scapoid replacement. The other options previously mentioned (styloidectomy, proximal row carpectomy, various fusions) are all potentially good options as well and can leave you with good dexterity.
You need to have a long discussion with a good hand surgeon where you discuss your goals and expectations.

As a student I scrubbed a couple of the vascularized grafts, including one that was 7 years out.

Your comments are excellent. New doesn't always equal better, and there seems to be a trend towards these fancy implants as an alternative to traditional, perhaps better-proven, therapies. Patients like the idea of a implant to mimic the normal anatomy, rather than removal/fusion procedures. I wonder if this is more of a marketing/perception issue than anything else.

If it were me, I'd ask a lot more questions about the PRC and vascularized graft before I'd even think about trying to find someone to do the scaphoid replacement.