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Questions for Dr Mark-re: Scaphoid Complication

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Hi Fellow riders, haven't been on the bike for a long time now with this scaphoid fracture, at first I was pretty optimistic with all this,but now realize the time it's gonna take.(could be a year!)

Any how with the what I have read here I thought maybe you could advise on my situation Dr mark, I would highly appreciate it.

Here's the story,

Casted on the 23 feb, no sign of fracture initially, 10 days later a definite crack halfway though the waist and another fracture in the distal pole.

Fast forward to 8 weeks in the cast total, x ray reveals no sign of fracture ( at least to me and the radiographer).

They let me go, started to move hand around, slight pain with about 10 deg flexion and extension.

2 days later report comes in, "there is incomplete bony healing of the transverse scaphoid waist fracture. Avascular necrosis is noted on the proximal pole with increasing sclerosis when compared to the previous films. There is also disuse osteopenia in the carpus. An orthopedic opinion maybe helpful".

After some Internet research, I have become real worried, even though my GP seemed unfazed with the report.

My GP rang an orthopedic surgeon(don't know if he is general or hand precialist yet) and he advised 2 more weeks in a cast and re-evaluate via regular x-ray.

X ray is next Wednesday, am hoping for improvement to say the least.

My questions are-

By casting a further 2 weeks , is the surgeon expecting that further healing of the fracture will eventually help re-vascularise the proximal pole?

If surgery is indicated (I thought AVN would force surgery straight up) am I better off going to a hand wrist specialist or the regional orthopedic doctor?

Should they be performing an MRI with intravenous contrast to check for proximal pole viability?

Sorry for the long post, just thought some detail would wrap it up in one post.

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Dead or alive, the non-healing bone needs to get fixed.  Therefore there is no reason to do some expensive and likely nondiagnositc test before.  An Orthopaedic surgeon or a hand specialist is qualified to repair this fracture.  There are A riders, and D riders amongst both groups.

 

Cant say I can imagine what another two weeks will do. But it gives you and the doc time to think out a plan.

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Thanks for the speedy reply Dr Mark, I guess it's a gamble with any surgeon.

So even at 10 weeks we can call it delayed union?

What treatment would you recommend , I am predicting maybe a vascularied bone graft and screw?

Again, I appreciate your input, as I know you have treated many of these.

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FYI - I went through this exact same process about 6 years ago. When the ER confirmed a fracture I went to my ortho rather than the hand specialists I was referred to. My options were surgergy & 4 weeks in a cast or no surgery 6-8 weeks in a cast. I opted no surgery. Many xrays, 3 casts & 5 months later it was healed. In hindsight I wish I would have went to the hand specialists & had it fixed but there was no way to know that 6-8 weeks would turn into 5+ months.

 

I'm nobody, but my reccomendation is to fix it right.

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Thanks for the input wakin, I welcome any advice/experiences.

In order to have surgery by the hand specialists I will have to fork out for the whole procedure however.

The transport accident commission here will reimburse me(rego on the bike) but I am still waiting

On confirmation of my claim being successful.

I wouldn't be freaked out so much if it weren't for the AVN showing up.

If my wrist is not repaired, I will lose two things I love, riding dirt bikes and my job as a fitter/machinist.

Being stuck at home reading all I can about scaphoid fracture treatment kind of plays on your mind!

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I feel for you SK, reality is hard to accept sometimes. I had total knee replacement last November & I still can't get more than 12 degrees on my extension. I work my a$$ off rehabbing. On top of that I'm facing a shoulder replacement but after the knee, there is a slim chance mentally I could go through that hell again anytime soon. I got on the bike 2 weeks ago for the first time, just grit your teeth through the pain & ride on.

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