![]() Consequently, the take-home message is, again, to seek medical attention when falls onto an outstretched hand occur and wrist pain persists for more than 24 hours. It should be noted that the success rate of surgery in an established nonunion is measurably lower than when either surgical and nonsurgical treatment options are instituted soon after the actual injury. Once the fracture becomes an established nonunion, surgery, except in some very young patients (children), becomes the only viable option to try to achieve a healed bone. Lastly, when a patient fails to present for evaluation early enough, the fracture will likely go on to what is known as a “nonunion”, the medical term for the circumstance where the bone fails to heal. Surgery is the preferred treatment option when the pieces of the scaphoid are found initially to be significantly displaced from one another, when there is no evidence of healing after 6-12 weeks of immobilization in a cast, or when patient-specific work or sports demands preclude having the liberty to undergo as much as 3 months of casting only to find out that the scaphoid may not have healed, making surgery necessary. Specifically, the number of blood vessels that enter the bone is quite limited and therefore, the ability of the bone to heal itself is less robust compared to other bones. This particularly long stretch of time has to do with the somewhat unique anatomy of the blood supply of the scaphoid bone. If casting seems feasible, the duration of immobilization is between 6 and 12 weeks. If x-rays do, in fact, reveal a fracture, further evaluation may be necessary with a CAT scan or MRI to assess whether or not the pieces into which the scaphoid broke are properly lined up to allow healing without surgery. Therefore, one would be well advised to seek orthopedic evaluation if wrist pain persists for more than 24-48 hours, even if mild, after a fall onto an outstretched hand. Sometimes the patient will have immediate pain on the thumb side of the wrist but oftentimes, especially when this is an injury that occurs while playing sports, the pain is not so bad that the athlete feels it necessary to stop playing. The typical mechanism of injury is a fall onto an outstretched hand. It is located on the thumb side of the wrist. The first such bone is the scaphoid, also known as the carpal navicular. To make matters worse, when these fractures are not diagnosed early, it becomes much more difficult to get them to heal later on. Furthermore, even when a patient does present acutely after such an injury, the fractures are often either not initially visible on x-rays or if they are, they are missed on the x-ray reading. Two of them, in particular, are subject to fractures that are often not painful enough to seek attention immediately after the injury. Within the wrist, there are eight small bones known as the carpal bones.
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