why so long in a cast for a non union fracture of scaphoid bone?

Question

I've had a broken wrist since july 06 i had surgery on dec 11th and i have long ways to go in a cast my follow up app. march 13th and it makes 9 months in casts

Answer 1

The scaphoid has a backwards blood supply. Instead of coming in at the top of the bone and heading towards the fingers, the single artery that feeds the bone its blood comes in at the bottom and heads up. Because of this, the artery often gets severed or damaged when the bone breaks (don't worry, you're not going to bleed to death) and then is unable to properly feed the rest of the bone. In addition to this, the location of the scaphoid makes it virtually impossible to totally immobilize without a long-arm cast (past your elbow) so the bone ends do not necessarily stay together all the time. As well, the location of the break frequently tells us how well or how poorly the bone may heal (a break in the top - proximal pole - is the most likely to not heal properly).

If the bone does not heal, you are at risk of avascular necrosis (death of tissue due to lack of blood supply) and at a minimum, it will cause arthritis in the joint, at worst, the joint may spontaneously fuse.

Your doc is keeping you in a cast for what seems like forever to try and prevent long term problems with the wrist. Bearing that in mind, you will likely go into a splint when the cast comes off and begin some physio or occupational therapy. 9 months without using a hand will cause significant muscle wasting and stiffness.

I know it seems like forever, but your doc tried to give it plenty of time to heal before surgery - he is being just as cautious after surgery to make sure that the screw is not the only thing holding the bone together.

Hope that helps, and sorry that you are dealing with it in the first place.

Answer 2

Previous poster was incorrect. By definition non-union means the bone has not healed! (It has nothing to do with how clean the original break was.) The question is why hasn't it healed? The bones of the wrist (carpals) have a very poor blood supply. The fracture itself can disrupt these fairly delicate blood vessels. If the blood flow to the bone is poor, the bone will not heal well as it is not getting what it needs to heal, oxygen and protein.

Answer 3

There are numerous reasons for slow healing of bones
Poor calcium uptake
Age
Diabetes
Poor blood supply to the area
Infection
the fracture being unstable or set too far apart so that healing is delayed.
This can usually be seen on the check xray when the cast is applied so I doubt that this one is valid.

You have not supplied sufficient information for an accurate answer to be given. Therfore i suggest that on your next visitt that you get the medical officer to explain this lenghty healing time to you and say why it is that you are having this problem.

Answer 4

First you may hotel a criticism with the Board of drugs interior the state you observed this scientific expert, some circumstances a scaphoid fracture with no longer look on the beginning up and in basic terms exhibits up after the bone tries to heal itself via forming a callus (new bone) around the fracture that may soak as much as approximately 2 weeks to type. i don't be attentive to in case you have a case yet you need to touch a malpractice legal expert on your city to inspect it. Sorry you had to flow with the aid of lots and need you're greater effectual now.

Answer 5

Non union means the bones were not cleanly broken and they were not in good alignment. You obviously needed the corrected and thus need a cast longer than somone who has a clean break.

Answer 6

Hard to say without more info. How is your calcium level, how old are you, what type of fracture ( compressional, twisting etc.), are there screws that might damage other bones if allowed free motion? Want a good answer add more info.