Scaphoid non-union

The scaphoid is a small bone in the wrist. This is prone to fracture after a fall on an outstretched hand. This fracture is not always visible on X-rays and may be missed. Often the x-rays are repeated about 10-14 days later. If a fracture is suspected but not seen on X-ray, a scan may be required.

Once identified, most are treated with plaster for a minimum of 6 weeks. Displaced fractures are treated with surgery.

Most of the untreated fractures and even some of those treated in plaster may not heal and will develop a non-union.

In these situations, the patient may be symptomatic with pain on wrist extension and on loading of the wrist. The pain is usually on the radial side (thumb side) of the wrist.

Once non-union is established, this will be seen on an X-ray.

The treatment is often surgery involving the use of bone graft and a screw fixation. Patients undergoing this surgery are likely to be in plaster for at least 6 weeks after the surgery.