Scaphoid fracture surgery Perth
Scaphoid
fracture surgery
The scaphoid is a small bone near the base of the thumb that plays an important role in wrist movement. A fracture of this bone is often mistaken for a sprain; pain may settle quickly and early X-rays can look normal. Unlike many other wrist bones, the scaphoid does not always heal on its own. Without treatment, it may not unite, which can lead to stiffness, weakness or arthritis. Early diagnosis and timely treatment matter.
At The Wrist + Hand Institute Perth, our wrist and hand surgeons use advanced arthroscopic and minimally invasive techniques to treat both new scaphoid fractures and longstanding scaphoid non-unions.
Common concerns
Patients often worry that surgery for a scaphoid fracture means a long recovery or difficulty returning to sport or work. The scaphoid is different from other wrist bones because of its unique blood supply, which means healing can be problematic. This is why early diagnosis and timely treatment are so important; they can make a real difference to long-term wrist function.
What is a scaphoid fracture?
The scaphoid is a small carpal bone near the base of the thumb that helps the wrist move smoothly. A scaphoid fracture is often caused by a fall onto an outstretched hand and may only result in transient pain or discomfort. The fracture may not be evident on X-ray. For these reasons, a scaphoid fracture can be dismissed as a minor ‘wrist sprain’. Diagnosis is made using CT and/or MRI scan.These injuries require urgent specialist review because of the risk of scaphoid non-union, avascular collapse and arthritis.
Do all scaphoid fractures need surgery?
Who this surgery is for
Scaphoid fracture surgery may be recommended if:
- The fracture is displaced or unstable.
- There is a risk of non-union or delayed healing.
- The diagnosis was delayed or the injury was initially missed.
Scaphoid fractures require urgent specialist review. Without treatment, the bone may fail to unite (non-union), which can cause long-term stiffness, weakness and arthritis. If a scaphoid non-union is left untreated, one of the bone fragments can lose blood supply (avascular necrosis). Over time, the avascular bone may collapse, severely affecting wrist function. There are surgical options for avascular non-union; your surgeon will discuss what is appropriate based on your history and imaging.
Diagnosis often requires a CT or MRI scan; plain X-rays can miss early fractures.
Types and options
Treatment depends on whether the fracture is recent (acute) or if it has been missed or hasn’t healed (non-union).
Arthroscopic fixation of scaphoid fractures
If diagnosed early, arthroscopic fixation is usually recommended. This minimally invasive technique uses a small camera and instruments to align the bone and secure it with a screw. Many surgeons, including our team, consider screw fixation for acute fractures a reliable way to reduce the risk of delayed union or non-union. By using an arthroscopic ‘keyhole’ technique,only small incisions need to be made, meaning less scarring and a quicker recovery. It also means that the wrist can be checked for other associated injuries, like torn ligaments.
Arthroscopic bone graft for scaphoid non-union
If the fracture was missed or hasn’t healed, more complex surgery may be needed. Arthroscopic bone grafting involves insertion of fine instruments through ‘keyhole’ portals to remove the non-uniting edges of the bone, revealing a surface with good blood supply to encourage healing. Wires are inserted to stabilise the fracture. Bone graft is then harvested from the iliac crest (the hip), processed until it is fine and then inserted through a cannula into the bone defect in the scaphoid. When union is confirmed on imaging (usually around 12 weeks after the surgery), the wires are removed and a screw is inserted. Advances in arthroscopic bone grafting have made this procedure more effective and less disruptive than older open techniques. Our Perth-based wrist surgeons have published a paper on this technique and presented their results internationally.
What happens in surgery?
For arthroscopic fixation of recent fractures, small keyhole incisions are made in the wrist to insert a camera and instruments. The fracture is aligned under direct vision and fixed with a screw. Alignment is confirmed on X-rays taken in the operating theatre. This procedure can be performed under local anaesthetic with sedation or under general anaesthetic. Most patients go home the next day.
For bone graft surgery, instruments are inserted through small keyhole incisions and the fracture site excised to reveal healthy bone. A bone graft is harvested from the hip, processed and inserted into the scaphoid defect. The fracture is stabilised with wires. This is a longer operation usually performed under general anaesthetic, sometimes with a ‘block’ for pain relief. Most patients stay one night in hospital. Around 12 weeks, once healing is confirmed, the wires are removed and a screw is inserted.
Recovery and results
Arthroscopic fixation (recent fractures)
The wrist is supported in a splint for 6 weeks or until union is confirmed on imaging. Many patients return to light activity within weeks, although full healing may take several months.
Arthroscopic bone graft for non-union
This is a bigger operation with longer recovery. The wrist is protected in a splint and full healing can take months. Hand therapy is an essential component of recovery to restore strength and motion.
Even with surgery, some fractures may be slow to unite and there is a small risk of ongoing stiffness, pain, delayed union and non-union.
Surgery risks
As with any operation, scaphoid surgery carries risks. These include infection, bleeding, nerve or vessel injury, stiffness, pain, delayed union or non-union. There are also small risks linked to anaesthesia, which your anaesthetist will explain before surgery.
Wrist surgeon Perth
Next steps
If you’ve injured your wrist or have ongoing pain after a fall, it’s important to get a specialist opinion to identify the cause. This can prevent long-term problems or large, complex surgery down the track. Scaphoid fractures can be hard to detect; with timely diagnosis and appropriate treatment, most people retain good wrist function.
The Wrist + Hand Institute Perth operates at multiple hospitals including Bethesda Hospital (Claremont), Hollywood Hospital, St John of God Mt Lawley, South Perth Hospital and Sundew Day Surgery.
Frequently Asked Questions
What’s the difference between arthroscopic fixation and bone graft surgery for scaphoid fractures?
- Arthroscopic fixation is used for recent (acute) fractures. Through tiny keyhole incisions, a small camera and instruments are used to align the fracture and fix it with a screw. This may reduce the risk of delayed union, non-union or arthritis caused by avascular collapse of the bone.
- Bone graft surgery is used when the fracture hasn’t healed or was diagnosed late. Using arthroscopic keyhole portals, the edges of the fracture are excised to reveal healthy bone to promote healing. The scaphoid is stabilised using wires. Bone graft is taken from the hip and inserted into the defect. At 12 weeks, when union is confirmed, the wires are removed and replaced with a screw.