Therapy of a scaphoid fracture


Like all fractions, the Scaphoid fracture can be treated conservatively in a cast or through surgery.

The indication for a conservative approach are undisplaced fractures of the scaphoid bone.

Due to the very slow fracture healing, the duration of the plaster therapy is extremely long.
For the first 6 weeks should be a Upper arm cast with thumb inclusion be created. If the x-ray shows that the bone has healed, it can be followed by a Forearm cast with thumb inclusion change.

Painkillers can also be used around Pain in the navicular bone to treat.

X-rays should be checked after one day, after one week, then after the 6th and 12th week.
Despite optimal follow-up treatment, there are cases in which the fracture does not heal conservatively.

A operative care should be used for displaced fractures, especially oblique fractures and transverse fractures, as the probability that the fracture will not heal is higher here.

Furthermore, surgical therapy should be undertaken for those who fear that there are capsules or parts of the ligament in the fracture gap which could interfere with the healing of the fracture.

Another indication for surgical therapy is the failure to heal the fracture after 12 weeks of conservative therapy or the circulatory disorder in the portion of the bone near the wrist (proximal fragment).


Special screws are now available for initial surgical treatment of the scaphoid fracture. First, both bone parts are threaded with a wire and brought together again in an ideal fit (pieced together) and then drilled over with a hollow screw (cannulated screw) and both fragments are pressed together as a lag screw. In some cases, the wire is dispensed with during the operation and the fragments are screwed in directly (e.g. Herbert screw).

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In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
In our very economic world in particular, there is too little time to thoroughly grasp the complex diseases of orthopedics and thus initiate targeted treatment.
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The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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As a follow-up treatment, however, this is followed by a 4 to 6 week immobilization in a cast. A general resilience is achieved after approx. 10 weeks. A maximum sporting load can usually only be carried out again after 4 - 6 months.

After removing the plaster of paris, the physiotherapy and occupational therapy Follow-up treatment can be started.

In the case of old fractures that have not grown together for months or years (so-called pseudarthrosis), screwing is no longer sufficient. In these cases, living bone must be “borrowed” from the patient's iliac crest. Old scar tissue is removed from the fracture line and a fresh block of bone from the Pelvic bones bolted. The surgical technique is called Matti-Russe after the original description, sometimes also called Matti-Russe-Plastik.

In addition to the "classic risks" of surgical therapy such as infection, wound healing disorders, thrombosis, embolism, deafness and paralysis, Sudeck's disease is feared in the hand area. You can find more about Sudeck's disease at vegetative reflex dystrophy.


The forecast is favorable for surgical and conservative therapy. Nevertheless, there are therapy failures in both forms of therapy, that is, a bone fracture does not heal.

An untreated scaphoid fracture generally ends in a false joint formation (pseudarthrosis), which can be symptom-free and can only cause problems years after the fall. It should be noted that a not inconsiderable proportion of scaphoid fractures are initially invisible and can therefore be overlooked.

The prognosis is unfavorable for oblique fractures in the part near the wrist (proximal). These fractures tend to fail to heal even under therapy. Pain in the wrist on the thumb side due to instability and consequences can result arthrosis be.


The scaphoid fracture can be healed with or without surgery. How the fracture is treated is ultimately dependent on the type of fracture itself.Fractures in the distal two thirds can be treated conservatively. The distal third is immobilized for about 6-8 weeks. The middle third should be immobilized for 10-12 weeks due to the poor blood supply. Surgery is always indicated for fractures of the proximal third. Such a scaphoid fracture should always be screwed.