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Dr.Mark on scaphoids?

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Dr Mark awesome effort on the forum btw :thumbsup:

Have you worked with scaphoids much? Im at a loss as what is best to do for my wrist. Here goes anyway, im hoping you can suggest what course of action to take, treatments to seek (laser, electric pulsing kit etc).

Fracture March 04. 80mph highside. Nuclear scan revealed fresh break and also damage to top of (ulna?) big forearm bone.

Surgery1 July 04 screw fixation. 1 year on it was fairly strong but still only about 60%. X-ray showed non union and screw migrating.

Surgery2 October 05. Pelvic bone graft and screw fixation.

3 months post op no signs of healing. bone stable and fracture sperated only a little. fractured in 2 places but still alive.

Jan 06. In desperation had hyperbaric oxygen, laser and magnetic pulsing alongside acupunture to relieve pain in press up position.

TODAY still no better :bonk:

SO, If you were in my boots what would you do? (limited budget and NHS only). Like would you keep riding, push for further surgery, give more time, buy a home stimulator etc.??? :thumbsup:

Appreciate any advice

Jim

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Sounds like you need to get a better surgeon. Did you go to a hand specialist? If so and it was pinned then did you put in the time for proper rehab? If you pushed it too soon, then that might have caused the non-union and it was probably never really healed before you began your activities. Sounds like something wrong with the rehab as well as you have had a recent surgery and after 3 months it hasn't healed? What did you do during that time for rehab? Were you out doing things you shouldn't have been doing?

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Jim, post a copy of you most recent X-ray. The biggest problem is the NHS. They could care less for anyone.

It it easy for doctors who have never ridden MX to confuse an MX related fractured scafoid (a high energy one) with a more common (low energy one)

The high energy ones usually have had more displacement and soft tissue damage.

So, an MXer with a sprained wrist must be followed by a doctor who understands that a scafoid fracture may initially look like a wrist sprain. I MRI all MX related sprained wrists that come to my clinic, as I have a high index of suspicion that such a prob em may be present.

Once the diagnosis is made, this fracture requires aggressive treatment. The long arm cast, worn forever, is not longer reliable enough for 2006. This fracture requires an open reduction with a headless screw and perhaps a bone graft if there is communited or pulverized bone.

After operation, a custom made brace is worn.

The healing rates of the fractured scafoid depend on the blood supply of the fragment of bone nearest the forearm. Its weird, but the blood supply of this bone comes in on the distal or thumb side and travels up the bone rather than down the bone. For this reason fractures nearer the forearm side of the bone don't get enough blood (the artery is broken along with the fracture, duh)

So, fractures near the thumb side heal easily in a month without surgery. Those nearest for forearm cause nothing but heartache. The ones in the middle are most common types and they can behave either way. For this reason, I am not going to even offer as a generality how long it takes for them to heal. The bad ones should have supplemental electric stimulation as soon as possible.

The idea of it all is to get the bone to heal before irreversible arthritic changes occur in the wrist. After they have occurred, a whole different set of problems and solutions come into effect.

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many thanks for the fast and comprehensive replies.

Yes, the NHS sucks! but, i cant afford £6000 for a private vascularised bone graft which i think is the only other (better) solution. I will try and get a copy of the X-Ray but they keep them all at the hospital on film so it may be difficult/ impossible!

Basically it is fractured stright across the middle, and also another small fracture on one side towards the radius. From what you have said, this looks like a very bad prospect of healing :thumbsup:

Since my last operation (bone graft) i did not do any sport for 10 weeks, then after physio started easy bike riding (As suggested by physio). I have not abused my wrist at all since the Op which adds to my frustration and confusion :bonk: i mainly go swimming/ running to keep fit now thats about it.

At my last checkup i was told it unlikely they would operate again, and they would look at fusing my wrist if I suffer from arthritis in the future. At 26 its quite depressing, although i know things could be worse. .

Is it worth pursuing further specialist physio treatment in you profesional opinion? or just give more time.

Ill try and get the Xray

Thanks again

J

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Put up a copy of the X-ray. Six thousand pounds? Wow, thats high!

It a lot less dear to have me work on it!

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ahh i love the NHS. £30 for a copy of the Xray

heres a sketch of the last Xray. LHS looking from inner to outer hand.

next checkup ill snap a digi pic when its up. .

doubt its much help im afraid

scaf1.jpg

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right ive sorted a link to my dodgy sketch.

it is my left wrist looking from inner to outer hand. the big fracture was the original break across the waist. the smaller break i did when i fell off again, just before the bone graft operation. .

ive seen picture of dying scaphoids and non unions , and it didnt show this on my last X-Ray. .

http://jamesstrachan9254.fotopic.net/p25135799.html

watch do you think Dr.Mark?

Thanks

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Strak, is the proximal part dead? Did they ever say anything like that. If not and that is what the X-ray looks like, I suspect this will heal.

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hi mark,

no they never mentioned this im sure. When the proximal part (nearest radius) dies does it go a darker colour on the X-Ray? Both parts of the bone looked the same colour and luminence on X-Ray.

I wonder - if the bone has been fractured for nearly 2 years why has the proximal pole not died if the blood supply was broken along with the bone?

What timescale would you predict for healing in this case mark - I have researched alot and am guessing 6 months from graft operation is realistic?

And would you carry on riding now or refrain from contact & dangerous sports (with a good brace) until healing on X-Ray?

Are home electric filed stimulators effective?

Too many questions sorry. .

thanks again :thumbsup:

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If the proximal pole is dead, its whiter on the x-ray than the rest of the bone.

If it is alive, there is potential for it to heal. Riding is okay if you can guarantee me that you won't fall.

Give this nasty one as much as a year to heal. Hope it heals earlier than that.

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