Many procedures are available to treat the stiffness, pain and weakness that can occur with arthritic conditions in the wrist.
Following a fall onto the wrist either ligament injuries or wrist bone fractures can occur.
The scaphoid bone is the most common carpal bone fracture easily fractured.
Occasionally x rays can initially look quite normal.
Aching pain at the base of the thumb may indicate fracture
and urgent CT scan or MRI should be performed.
The wrist should be splinted until fracture is excluded.
Occasionally the fracture will not heal despite splinting.
Non-union of a scaphoid fracture is commoner in smokers
or with diplaced fractures or fractures of the proximal pole
These fractures are probably best treated initially by screw fixation.
Persistant non union may lead to wrist arthritis. also called
Scaphoid non-union advanced collapse SNAC wrist
or periscaphoid arthritis.
Thus treatment of non union before arthritis develops is essential.
The surgical treatment of a non union.
is usually with fracture excision and interpositional bone grafting.
If the fracture is thought to be avascular
then vascularised bone graft may be required.
It is difficult to assess vascularity but
MRI scans with gadolineum enhancement may be useful.
There are three commonly used vascularised bone grafts.
1. From the dorsal or bach of the wrist based on retinaculum vessels.
2. From the front or volar side based on the volar wrist arcade vessels.
3. From the medial femoral condyle as a free tissue transfer
(useful if larger ammounts of well vasclareised bone are necessary).
Standard non vascularised bone grafts
are normally taken fron the distal radius
near the scaphoid fracture site.
or occasionally the hip (iliac crest).
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