This handout explains the follow-up care after surgery to repair your scaphoid fracture or nonunion. The scaphoid is difficult to heal because of the limited blood supply that enters at the tip of the bone (Fig. 1). A headless screw has been designed to fix the fracture without irritating the joint and it usually does not need to be removed (Fig.2). In most cases the fracture collapsed the scaphoid and a bone graft plus the screw corrects the collapsed scaphoid (Fig.3). The cast is there for your protection. It is important to move your fingers to avoid stiffness, but please do not lift anything heavy with the operable hand. During the surgery, it was important to stabilize the scaphoid bone with a small, specially designed screw. In some cases, it is necessary to insert a drain to remove excess fluid and avoid infection. Please take the antibiotic that was prescribed until the drain has been removed. We can schedule to remove the drain for you 48 hours after surgery. Alternatively, you may remove this at home if you feel comfortable and the nurses in the postoperative area will review this with you. Please see our pain management form for more detailed information on how to avoid pain, nausea and constipation. If the incision is red or if there is drainage coming out of it, please call us right away at the phone number listed at the bottom of this page. Go to the emergency room if this occurs at a night or on a weekend.

Wound Care:

  • After surgery, most patients have their arm placed in a bulky dressing (bandage) or a plaster splint that extends above the elbow.
  • Depending on the complexity of the fracture and/or nonunion, the incisions can include either the back of the hand, the front of the hand, or both.

Pain Management:

  • You will receive a prescription for narcotic pain medication. Take this with your medication, as directed. It is important to “stay ahead” of your pain medication and avoid having to play “catch up” for significant increases in pain. Medication for nausea will also be provided.
  • Please make sure to check with the postoperative nurses and the office staff at Bellevue Bone & Joint Physicians about how to manage your pain medication. To best manage your pain, you must take the pain medication the way it was prescribed. Taking the correct dose at the right time is very important.
  • If you have uncomfortable side effects from the pain medication, please call us at 425-462-9800.
  • Please see “medications after surgery information” form for more instructions.
  • It is normal to have some pain off and on for approximately one year after surgery, particularly in cold weather.

Driving:

  • Do not drive if you are taking narcotic medications, it is not safe and against Washington state law. Taking medication can make you sleepy and delay your reaction time.
  • Once you are no longer taking narcotic medication, you may drive as soon as you can comfortably grip the steering wheel with both hands.

Activity:

  • Keep your arm elevated as much as possible throughout the day, to reduce swelling.
  • Begin exercising your fingers gently after surgery by to bending and straightening your fingers as much as the dressing will allow.
  • Please exercise your shoulder several times a day by raising your arm over your head because you will not be able to use your hand and arm for everyday activities.

Follow-Up:

  • Your sutures will be removed at 10-14 days after surgery.
  • Your hand or arm will be placed in a splint or fiberglass cast that includes the thumb and wrist (thumb-spica cast). If you have a nonunion (a long-term fracture that has not healed) your cast will often go above the elbow.
  • The initial cast or splint is worn full time for four to six weeks.
  • At the next follow-up visit in the office, x-rays will be taken to determine bone healing and the placement of the implants. Depending on the quality of healing, additional casting or bracing may be recommended.
  • If you have a nonunion, you will have to wear a short arm thumb-spica cast or brace for at least three months after the surgery.
  • Scaphoid fractures take longer to heal because there is poor blood supply to the bone. For patients with scaphoid nonunions, we often prescribe a bone stimulator to help the bone heal. This device straps around the cast and can be worn at night. You must get approval from your insurance company before using the device.
  • After your cast is removed your hand or arm will be placed into a removable splint until x-rays confirm that the scaphoid has fully healed. You will be referred to a hand therapist to begin wrist exercise.

Results:

Scaphoid fractures or nonunions are very critical injuries. If your fracture does not heal, there is a risk of developing arthritis. By using both internal fixation and bone grafting (for nonunions) or internal fixation alone (for acute injuries), most patients recover almost full motion and strength. It may take 6-12 months after the first surgery for this amount of recovery to occur.


Thomas E. Trumble, M.D.

*Figures courtesy of Principles of Hand Surgery and Therapy by Thomas E. Trumble, MD, Ghazi M. Rayan, MD, Mark E. Baratz, MD and Jeffrey E. Budoff, MD